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General NPI Number Information
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NPI Number | 1023227238
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Entity Type | Individual
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Provider Name | COLLEEN MARGARET PETERSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4505 S MARYLAND PKWY BOX 453047
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City | LAS VEGAS
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State | NV
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Zip | 89154-9900
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Country | US
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Telephone | 702-895-4798
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Fax | 702-895-4797
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Provider Business Mailing Address
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Address Line | 1796 BAJA LN
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City | HENDERSON
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State | NV
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Zip | 89012-3108
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Country | US
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Telephone | 702-269-5781
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Fax | 702-895-4797
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0850
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License Number State | NV
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