MEDICARE: PETERSEN ENTERPRISES INC

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	101Y00000X	Counselor	2179	CO

General Provider Information

NPI Number	:	1518356484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSEN ENTERPRISES INC

Provider Business Mailing Address
First Line	:	4213 DURANGO PL
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-4103
Country	:	US
Telephone Number	:	970-234-1147
Fax Number	:

Provider Business Practice Location Address
First Line	:	4529 STOVER ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3261
Country	:	US
Telephone Number	:	970-234-1147
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JENNIFER PETERSEN
Credential	:	MA, LPC
Telephone Number	:	970-234-1147

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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Directions to “PETERSEN ENTERPRISES INC ” Practice Location

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