Provider Demographics
NPI:1962111476
Name:PETERSON, CARTER BAXTER (LPC)
Entity type:Individual
Prefix:
First Name:CARTER
Middle Name:BAXTER
Last Name:PETERSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 HIGHLAND VIS
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6839
Mailing Address - Country:US
Mailing Address - Phone:281-723-1493
Mailing Address - Fax:
Practice Address - Street 1:2003 MEDICAL PKWY STE C
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7554
Practice Address - Country:US
Practice Address - Phone:830-730-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional