Provider Demographics
NPI:1487050357
Name:PETERS, BRITTON
Entity type:Individual
Prefix:
First Name:BRITTON
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 MERCURY AVE SE APT 204
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-4006
Mailing Address - Country:US
Mailing Address - Phone:803-673-3320
Mailing Address - Fax:
Practice Address - Street 1:216 BOYETT LN
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:TX
Practice Address - Zip Code:75930-5841
Practice Address - Country:US
Practice Address - Phone:803-673-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WALH60732590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)