Doctor Name: | MS. JUDETH PETERSEN |
NPI Number: | 1033263652 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., LPC |
License Number: | 1512 |
Business Practice Address: | 501 S Burma Ave Gillette, WY - 827163426 |
Business Phone Number: | 3076885000 |
Business Fax Number: | 3076885015 |
Mailing Address: | 501 S Burma Ave, GILLETTE |
State: | WY |
Postal Code: | 827163426 |
Phone Number: | 3076885000 |
Fax Number: | 3076885015 |
NPI Enumeration Date: | 01/22/2007 |
NPI Last Update Date: | 08/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 1512 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ND |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |