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General NPI Number Information
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NPI Number | 1154575017
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Entity Type | Individual
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Provider Name | TERRY LYNN PETERSON LMSW
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Gender | Male
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 1601 S SHEPHERD DR APT 115
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City | HOUSTON
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State | TX
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Zip | 77019-3534
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Country | US
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Telephone | 713-927-9892
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Fax | 281-442-4904
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Provider Business Mailing Address
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Address Line | 1601 S SHEPHERD DR APT 115
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City | HOUSTON
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State | TX
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Zip | 77019-3534
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Country | US
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Telephone | 713-927-9892
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Fax | 281-442-4904
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 52185
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License Number State | TX
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