Healthcare Provider Details

I. General information

NPI: 1841381332
Provider Name (Legal Business Name): RICHARD M PETERSEN L.M.F.T. M.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMEDDAC WUERZBURG, ANSBACH MIDDLE HIGH SCHOOL
ANSBACH GERMANY
09177
DE

IV. Provider business mailing address

USAMEDDAC WUERZBURG, UNIT 26610 ATTN: CREDENTIALS OFFICE
APO AE
09244
DE

V. Phone/Fax

Practice location:
  • Phone: 09802832153
  • Fax: 098021496
Mailing address:
  • Phone: 01149931843616
  • Fax: 011499318043241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberB23678
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number#36434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: