Provider Demographics
NPI:1538282769
Name:PETERSON, ALAN LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LEE
Last Name:PETERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 IH-10 WEST
Mailing Address - Street 2:SUITE 1325
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-562-6700
Mailing Address - Fax:
Practice Address - Street 1:7550 W IH 10
Practice Address - Street 2:SUITE 1325
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5803
Practice Address - Country:US
Practice Address - Phone:210-562-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical