Healthcare Provider Details

I. General information

NPI: 1457653529
Provider Name (Legal Business Name): MEIRA PETERSEN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALIENTE RD STE 2B
SANTA FE NM
87508-9102
US

IV. Provider business mailing address

5 CALIENTE RD STE 2B
SANTA FE NM
87508-9102
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-5481
  • Fax:
Mailing address:
  • Phone: 505-231-5481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0165401
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: