Provider Demographics
NPI:1215717350
Name:DARBI PETERSON
Entity type:Organization
Organization Name:DARBI PETERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARBI
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:469-588-6727
Mailing Address - Street 1:250 AQUA MARINE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2269
Mailing Address - Country:US
Mailing Address - Phone:469-588-6727
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4298
Practice Address - Country:US
Practice Address - Phone:469-588-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLOOM MENTAL HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)