Provider Demographics
NPI:1427456540
Name:SECOLA, PETER (LPA)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SECOLA
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E TAYLOR ST
Mailing Address - Street 2:SUITE 4011
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2881
Mailing Address - Country:US
Mailing Address - Phone:903-893-0298
Mailing Address - Fax:903-892-6323
Practice Address - Street 1:600 E TAYLOR ST
Practice Address - Street 2:SUITE 4011
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2881
Practice Address - Country:US
Practice Address - Phone:903-893-0298
Practice Address - Fax:903-892-6323
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-06
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36910103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical