Provider Demographics
NPI:1679582811
Name:PETERS, KATHLEEN (LMFT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 NEW HARTFORD RD STE 401
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1782
Mailing Address - Country:US
Mailing Address - Phone:270-926-4880
Mailing Address - Fax:270-926-4883
Practice Address - Street 1:3520 NEW HARTFORD RD STE 401
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1782
Practice Address - Country:US
Practice Address - Phone:270-926-4880
Practice Address - Fax:270-926-4883
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY#0508106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist