Basic Information
| Provider Information | |||||||||
| NPI: | 1760518880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMFT, LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 747 | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665050747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855874300 | ||||||||
| FaxNumber: | 7855874377 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 W 21ST ST | ||||||||
| Address2: | |||||||||
| City: | CONCORDIA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 669015200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852438900 | ||||||||
| FaxNumber: | 7852438933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2007 | ||||||||
| LastUpdateDate: | 01/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 385 | OK | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 1013 | KS | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YA0400X | 228 | KS | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 200587790A | 05 | KS | MEDICAID |