1508981168 NPI number — MR. RICHARD STEPHEN PETERSON LMFT

Table of content: MR. RICHARD STEPHEN PETERSON LMFT (NPI 1508981168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508981168 NPI number — MR. RICHARD STEPHEN PETERSON LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERSON
Provider First Name:
RICHARD
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508981168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7352
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRECKELS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93962-7352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-915-7434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 CENTRAL AVE STE 5E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93901-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-915-7434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 39664 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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