Healthcare Provider Details

I. General information

NPI: 1568815074
Provider Name (Legal Business Name): NANCY JUNE PETERSEN M.S., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/23/2022
Certification Date: 07/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 MAIN ST
TORRINGTON WY
82240-3340
US

IV. Provider business mailing address

2326 E G ST
TORRINGTON WY
82240-2518
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-4197
  • Fax:
Mailing address:
  • Phone: 308-637-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1579
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20687
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: