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General NPI Number Information
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NPI Number | 1700295326
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Entity Type | Individual
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Provider Name | MILTON PETERSON JR. LCDC
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Gender | Male
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 5711 LAVENDER ST
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City | HOUSTON
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State | TX
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Zip | 77026-1725
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Country | US
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Telephone | 713-557-8573
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Fax |
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Provider Business Mailing Address
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Address Line | 2353 AVENUE M APT 29
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City | HUNTSVILLE
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State | TX
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Zip | 77340-5752
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Country | US
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Telephone | 936-439-5746
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDC#696
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License Number State | TX
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