| Doctor Name: | LISA M PETERSEN |
| NPI Number: | 1063707305 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHP |
| License Number: | 8871 |
| Business Practice Address: | 801 Harmony St Suite 302 Council Bluffs, IA - 515033106 |
| Business Phone Number: | 7123282609 |
| Business Fax Number: | 7123289257 |
| Mailing Address: | 7261 Mercy Rd, OMAHA |
| State: | NE |
| Postal Code: | 681242311 |
| Phone Number: | 4023986248 |
| Fax Number: | 4028298513 |
| NPI Enumeration Date: | 06/15/2011 |
| NPI Last Update Date: | 08/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 8871 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |