Healthcare Provider Details

I. General information

NPI: 1609877232
Provider Name (Legal Business Name): JAMES WARNER PETERS MA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W 29TH ST
CHEYENNE WY
82001-2760
US

IV. Provider business mailing address

510 W 29TH ST
CHEYENNE WY
82001-2760
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-9362
  • Fax: 307-637-6852
Mailing address:
  • Phone: 307-632-9362
  • Fax: 307-637-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number593
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: