| Doctor Name: | KRISTINA PETERSEN |
| NPI Number: | 1104229806 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 13439 |
| Business Practice Address: | 2580 Hway 95 # 1250 Bullhead City, AZ - 864427491 |
| Business Phone Number: | 9287637776 |
| Business Fax Number: | 9287637786 |
| Mailing Address: | 3450 N 3rd St, PHOENIX |
| State: | AZ |
| Postal Code: | 850122331 |
| Phone Number: | 6022579339 |
| Fax Number: | 6022658533 |
| NPI Enumeration Date: | 10/08/2014 |
| NPI Last Update Date: | 10/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 13439 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |