| Doctor Name: | MS. ANN RENEE PETERSEN |
| NPI Number: | 1629170790 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.P.C.C., N.C.C. |
| License Number: | 0069062 |
| Business Practice Address: | 4686 Corrales Rd Corrales, NM - 870488610 |
| Business Phone Number: | 5054009913 |
| Business Fax Number: | 5058901527 |
| Mailing Address: | Po Box 3237, CORRALES |
| State: | NM |
| Postal Code: | 870483237 |
| Phone Number: | 5054009913 |
| Fax Number: | |
| NPI Enumeration Date: | 09/01/2006 |
| NPI Last Update Date: | 05/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0069062 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |