Provider Demographics
NPI:1487807947
Name:PETERSON, JANET M (PHD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:M
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11710 SOUTHLAKE DR
Mailing Address - Street 2:#3
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6750
Mailing Address - Country:US
Mailing Address - Phone:361-894-2255
Mailing Address - Fax:
Practice Address - Street 1:12450 W SUMMERLIN
Practice Address - Street 2:#3
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77302-3572
Practice Address - Country:US
Practice Address - Phone:832-764-9036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33641103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33641OtherLICENSE