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General NPI Number Information
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NPI Number | 1275526980
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Entity Type | Individual
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Provider Name | MICHELE LEE PETERSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/27/2005
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Last Update Date | 01/17/2025
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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 | 29970 TECHNOLOGY DR STE 216
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City | MURRIETA
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State | CA
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Zip | 92563-2649
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Country | US
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Telephone | 619-354-3812
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 73177
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 309873-3501
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License Number State | UT
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