Basic Information
| Provider Information | |||||||||
| NPI: | 1386171866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCPETERS | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | RHYS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1235 E ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937062024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592686261 | ||||||||
| FaxNumber: | 5592687518 | ||||||||
| Practice Location | |||||||||
| Address1: | 1235 E ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937062024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592686261 | ||||||||
| FaxNumber: | 5592687518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 122978 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.