Provider Demographics
NPI:1932955309
Name:PETERSON, CHLOE (RBT)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11006 RIVER STROLL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2524
Mailing Address - Country:US
Mailing Address - Phone:210-857-8697
Mailing Address - Fax:
Practice Address - Street 1:12770 CIMARRON PATH STE 118
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3415
Practice Address - Country:US
Practice Address - Phone:855-374-4900
Practice Address - Fax:855-322-3694
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-292099106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician