Provider Demographics
NPI:1538202635
Name:PETERS, TOM FERENCZIK
Entity type:Individual
Prefix:MR
First Name:TOM
Middle Name:FERENCZIK
Last Name:PETERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 E 6 TH STREET
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-0000
Mailing Address - Country:US
Mailing Address - Phone:909-284-0423
Mailing Address - Fax:909-284-0423
Practice Address - Street 1:1700 MCHENRY VILLAGE WAY # 11
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4308
Practice Address - Country:US
Practice Address - Phone:209-526-1476
Practice Address - Fax:209-526-0908
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49290101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health