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NPI Code Detail

MEDICARE: WILLIAM PETERSON II

MEDICARE: WILLIAM PETERSON II
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 Counselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1750092888
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM PETERSON II
Provider Business Mailing Address
First Line : 3559 STANFORD PL
Second Line :
City : DAYTON
State : OH
Zip : 45406-3641
Country : US
Telephone Number : 937-723-6893
Fax Number :
Provider Business Practice Location Address
First Line : 3559 STANFORD PL
Second Line :
City : DAYTON
State : OH
Zip : 45406-3641
Country : US
Telephone Number : 377-238-4759
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2022
Last Update Date : 06/13/2025

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Directions to “ WILLIAM PETERSON II ” Practice Location

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