MEDICARE: AMERICAN ASSOCIATION OF SOMATIC SEXOLOGISTS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP1600X	Pastoral Counselor
3	101Y00000X	Counselor
4	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1366319923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN ASSOCIATION OF SOMATIC SEXOLOGISTS

Provider Business Mailing Address
First Line	:	PO BOX 94932
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30377-1932
Country	:	US
Telephone Number	:	808-954-0224
Fax Number	:

Provider Business Practice Location Address
First Line	:	11539 LIGHTNING WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-3918
Country	:	US
Telephone Number	:	808-954-0224
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CRYSTAL AMINA PETERSON
Credential	:	SSE, CS, SEP
Telephone Number	:	808-954-0224

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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Directions to “AMERICAN ASSOCIATION OF SOMATIC SEXOLOGISTS ” Practice Location

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