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NPI Code Detail

MEDICARE: SANDRA H. PETERSON LPC, NCC

MEDICARE: SANDRA H. PETERSON LPC, NCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor14344TX

General Provider Information

NPI Number : 1386709475
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA H. PETERSON LPC, NCC
Provider Business Mailing Address
First Line : 14 BIRCHBROOK
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78254-5577
Country : US
Telephone Number : 210-279-7782
Fax Number : 210-543-1060
Provider Business Practice Location Address
First Line : 1978 BABCOCK RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-4512
Country : US
Telephone Number : 210-279-7782
Fax Number : 210-543-1060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2006
Last Update Date : 07/08/2007

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Directions to “ SANDRA H. PETERSON LPC, NCC” Practice Location

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