Provider Demographics
NPI:1427251198
Name:PETERS, SEAN M (PHD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:PETERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 VINTAGE PARK BLVD
Mailing Address - Street 2:STE W
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4096
Mailing Address - Country:US
Mailing Address - Phone:281-702-5142
Mailing Address - Fax:832-603-4403
Practice Address - Street 1:118 VINTAGE PARK BLVD
Practice Address - Street 2:STE W
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4096
Practice Address - Country:US
Practice Address - Phone:713-592-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31991103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157757901MedicaidTMPH