MEDICARE: PETERSEN BEHAVIOR CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1356283113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSEN BEHAVIOR CONSULTING LLC

Provider Business Mailing Address
First Line	:	7007 HAWAII KAI DR APT L12
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96825-4128
Country	:	US
Telephone Number	:	573-760-2488
Fax Number	:	808-320-2298

Provider Business Practice Location Address
First Line	:	7007 HAWAII KAI DR APT L12
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96825-4128
Country	:	US
Telephone Number	:	573-760-2488
Fax Number	:	808-320-2298

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAUREN PETERSEN
Credential	:	BCBA
Telephone Number	:	573-760-2488

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	06/09/2026

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