Provider Demographics
NPI:1316963697
Name:FERNANDO, SUMITH D PETER (LPC, LMFT, CCDC, CHT)
Entity type:Individual
Prefix:DR
First Name:SUMITH
Middle Name:D PETER
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:LPC, LMFT, CCDC, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CENTRAL DRIVE
Mailing Address - Street 2:STE 205
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:817-283-1420
Mailing Address - Fax:817-545-8574
Practice Address - Street 1:1901 CENTRAL DRIVE
Practice Address - Street 2:STE 205
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021
Practice Address - Country:US
Practice Address - Phone:817-283-1420
Practice Address - Fax:817-545-8574
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10654LPC101Y00000X
TX98LMFT101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10029878OtherAMERIGROUP