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General NPI Number Information
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NPI Number | 1043036775
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Entity Type | Organization
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Legal Business Name | MICHELE PETERSON LCSW A LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 27349 JEFFERSON AVE STE 102
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City | TEMECULA
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State | CA
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Zip | 92590-5611
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Country | US
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Telephone | 619-354-3812
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Fax |
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Provider Business Mailing Address
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Address Line | 24329 BAY LAUREL AVE
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City | MURRIETA
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State | CA
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Zip | 92562-2163
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Country | US
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Telephone | 435-817-7004
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHELE PETERSON
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Credential | LCSW
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Telephone | 435-817-7004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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