Healthcare Provider Details

I. General information

NPI: 1750674404
Provider Name (Legal Business Name): RACHEL ANN PETERSON M.S., L.A.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 N CROSSOVER RD
FAYETTEVILLE AR
72703-4591
US

IV. Provider business mailing address

4171 N CROSSOVER RD
FAYETTEVILLE AR
72703-4591
US

V. Phone/Fax

Practice location:
  • Phone: 479-575-9471
  • Fax:
Mailing address:
  • Phone: 479-575-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA1105047
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: