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General NPI Number Information
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NPI Number | 1215351747
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Entity Type | Individual
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Provider Name | KRISTIN MARIE PETERS LCPC, LPC, SAC
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Gender | Female
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Dates
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Enumeration Date | 02/04/2014
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 5536 S EVERETT AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1902
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Country | US
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Telephone | 773-643-6259
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15219
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City | CHICAGO
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State | IL
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Zip | 60615-5140
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Country | US
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Telephone | 773-643-6259
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6336-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.014620
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 16331
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15975-131
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License Number State | WI
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