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General NPI Number Information
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NPI Number | 1326259896
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Entity Type | Individual
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Provider Name | SHANDI PETERS LPC/MHSP
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Gender | Female
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 10/17/2020
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Provider Practice Location Address
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Address Line | 5505 EDMONSON PIKE STE 102
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City | NASHVILLE
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State | TN
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Zip | 37211-5869
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Country | US
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Telephone | 615-502-2129
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 RAPER SPRINGS RD
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City | TREMONT
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State | MS
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Zip | 38876-9102
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Country | US
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Telephone |
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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 | 5169
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License Number State | TN
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