Individual
EILEEN PETERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
2821 HILLEGAS RD, FORT WAYNE, IN 46808-3859
(260) 471-1950
Mailing address
2821 HILLEGAS RD, FORT WAYNE, IN 46808-3859
(260) 471-1950
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
99033624A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200530260A
—
IN
Enumeration date
09/04/2008
Last updated
09/05/2008
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