Provider Demographics
NPI:1043036775
Name:MICHELE PETERSON LCSW A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity type:Organization
Organization Name:MICHELE PETERSON LCSW A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-817-7004
Mailing Address - Street 1:24329 BAY LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2163
Mailing Address - Country:US
Mailing Address - Phone:435-817-7004
Mailing Address - Fax:
Practice Address - Street 1:27349 JEFFERSON AVE STE 102
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5611
Practice Address - Country:US
Practice Address - Phone:619-354-3812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty