Provider Demographics
NPI:1396237186
Name:STEPHENS, PETER (PSYD, LPCC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:PSYD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35334 MOUNTAIN VIEW ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4809
Mailing Address - Country:US
Mailing Address - Phone:951-640-9184
Mailing Address - Fax:909-421-9392
Practice Address - Street 1:25873 HEMET ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-5026
Practice Address - Country:US
Practice Address - Phone:951-765-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
CA11029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALPCC11029OtherBOARD OF BEHAVIORAL SCIENCES