Provider Demographics
NPI:1609856921
Name:PETERS, BARBARA A (LCPC)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:A
Last Name:PETERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5338 N STEPHEN DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3452
Mailing Address - Country:US
Mailing Address - Phone:309-691-8411
Mailing Address - Fax:
Practice Address - Street 1:5338 N STEPHEN DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3452
Practice Address - Country:US
Practice Address - Phone:309-691-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional