Healthcare Provider Details

I. General information

NPI: 1861402109
Provider Name (Legal Business Name): CHERI ANN PETERSON LCSW,LMFT, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 1ST ST NW # 2
CHOTEAU MT
59422-9423
US

IV. Provider business mailing address

PO BOX 727
BYNUM MT
59419-0727
US

V. Phone/Fax

Practice location:
  • Phone: 406-868-6902
  • Fax:
Mailing address:
  • Phone: 406-868-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-1065
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-760
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7004
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberSWP-LMFT-LIC-91
License Number StateMT
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWP-LCSW-LIC-709
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: