Provider Demographics
NPI:1386709475
Name:PETERSON, SANDRA H (LPC, NCC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:H
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BIRCHBROOK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5577
Mailing Address - Country:US
Mailing Address - Phone:210-279-7782
Mailing Address - Fax:210-543-1060
Practice Address - Street 1:1978 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4512
Practice Address - Country:US
Practice Address - Phone:210-279-7782
Practice Address - Fax:210-543-1060
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health