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General NPI Number Information
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NPI Number | 1780050625
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Entity Type | Individual
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Provider Name | JONATHAN PETERS LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 02/23/2020
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Provider Practice Location Address
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Address Line | 380 SUWANNEE TRAIL ST
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7956
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Country | US
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Telephone | 270-901-5000
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Fax | 270-842-5268
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Provider Business Mailing Address
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Address Line | 380 SUWANNEE TRAIL ST
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7956
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Country | US
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Telephone | 270-901-5000
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Fax | 270-842-5268
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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 | 252567
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License Number State | KY
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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 | 254654
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License Number State | KY
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