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General NPI Number Information
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NPI Number | 1538282769
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Entity Type | Individual
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Provider Name | ALAN LEE PETERSON PHD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 7550 W IH 10 SUITE 1325
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5803
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Country | US
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Telephone | 210-562-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 3550 IH-10 WEST SUITE 1325
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City | SAN ANTONIO
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State | TX
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Zip | 78229
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Country | US
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Telephone | 210-562-6700
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 33040
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License Number State | TX
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