Organization
M FISCUS DAO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN PETERSON LP (OWNER)
(210) 935-2609
Entity
Organization
Contact information
Practice address
136 EXETER PLACE DR APT 11201, SAN ANTONIO, TX 78253-4256
(210) 935-2609
Mailing address
136 EXETER PLACE DR APT 11201, SAN ANTONIO, TX 78253-4256
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
01/20/2022
Last updated
01/20/2022
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