Doctor Name: | MR. PETER DOUGLAS NORDSTROM |
NPI Number: | 1033180849 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMHC |
License Number: | MH6961 |
Business Practice Address: | 114 St Clair Abrams Ave Tavares, FL - 32778 |
Business Phone Number: | 3522536300 |
Business Fax Number: | 3523437691 |
Mailing Address: | 4910 Abaco Dr, TAVARES |
State: | FL |
Postal Code: | 327784757 |
Phone Number: | 3522536300 |
Fax Number: | 3523437691 |
NPI Enumeration Date: | 01/30/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH6961 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |