Provider Demographics
NPI:1871730002
Name:PETERSON, STEPHANIE E (LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:909 NE LOOP 410 STE 800
Mailing Address - Street 2:ATTN: JACKIE GRAYSON
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1311
Mailing Address - Country:US
Mailing Address - Phone:210-832-5000
Mailing Address - Fax:210-832-5005
Practice Address - Street 1:7404 HWY 90 W
Practice Address - Street 2:BUILDING#7
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-4024
Practice Address - Country:US
Practice Address - Phone:210-832-5000
Practice Address - Fax:210-832-5005
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional