Provider Demographics
NPI:1447008420
Name:PETERS, BRIAN HENRY
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:HENRY
Last Name:PETERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 LAMAR DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-7354
Mailing Address - Country:US
Mailing Address - Phone:931-494-6803
Mailing Address - Fax:
Practice Address - Street 1:3929 LAMAR DR STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-7354
Practice Address - Country:US
Practice Address - Phone:931-494-6803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health