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General NPI Number Information
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NPI Number | 1124751524
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Entity Type | Individual
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Provider Name | TIANA PETERSON
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Gender | Female
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 1515 N POST RD STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4213
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Country | US
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Telephone | 317-282-3088
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Fax |
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Provider Business Mailing Address
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Address Line | 9263 COLLEGE DR APT A
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-4193
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Country | US
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Telephone | 317-597-5540
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Fax |
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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 |
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License Number State | IN
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