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1003284886 NPI number — STEPHEN WAYNE PETERSON LPCC

NPI Number: 1003284886
Health Care Provider/Practitioner: STEPHEN WAYNE PETERSON LPCC

Information about “1003284886” NPI (STEPHEN WAYNE PETERSON LPCC) exists in 1003284886 in HTML format HTML  |  1003284886 in plain Text format TXT  |  1003284886 in PDF (Portable Document Format) PDF  |  1003284886 in an XML format XML  formats.

NPI Number : 1003284886 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003284886",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETERSON",
    "FirstName": "STEPHEN",
    "MiddleName": "WAYNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LPCC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8630 QUEEN AVE S",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BLOOMINGTON",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55431-1904",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7400 METRO BLVD STE 220",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EDINA",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55439-2321",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "952-220-7164",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/09/2015",
    "LastUpdateDate": "05/01/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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