Provider Demographics
NPI:1548634512
Name:PETERS, SAMUEL (LPC)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:PETERS
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 1:751 HEBRON PKWY
Mailing Address - Street 2:STE. 320
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5055
Mailing Address - Country:US
Mailing Address - Phone:214-396-3848
Mailing Address - Fax:
Practice Address - Street 1:751 HEBRON PKWY
Practice Address - Street 2:STE. 320
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5055
Practice Address - Country:US
Practice Address - Phone:214-396-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72071101Y00000X, 101YM0800X, 101YP1600X, 101YP2500X
TX101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool