Provider Demographics
NPI:1023112216
Name:PETERS, PRISCILLA (MA, LPCC, PCC)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MA, LPCC, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 APACHE CIR
Mailing Address - Street 2:
Mailing Address - City:MADEIRA
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2403
Mailing Address - Country:US
Mailing Address - Phone:513-575-6777
Mailing Address - Fax:
Practice Address - Street 1:7654 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4204
Practice Address - Country:US
Practice Address - Phone:513-575-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY184607OtherMEDICARE GROUP NUMBER