Healthcare Provider Details

I. General information

NPI: 1811546252
Provider Name (Legal Business Name): LAURA JO PETERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CRAMER CREEK CT
DUBLIN OH
43017-2586
US

IV. Provider business mailing address

3636 HEYWOOD DR
HILLIARD OH
43026-1721
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-5722
  • Fax: 614-889-9335
Mailing address:
  • Phone: 614-286-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2202762-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: