Healthcare Provider Details

I. General information

NPI: 1376790741
Provider Name (Legal Business Name): MR. ANDREW NELSON PETERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 VALENCIA ST #222
SAN FRANCISCO CA
94103-3547
US

IV. Provider business mailing address

333 VALENCIA ST #222
SAN FRANCISCO CA
94103-3547
US

V. Phone/Fax

Practice location:
  • Phone: 415-864-2367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: