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General NPI Number Information
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NPI Number | 1255567608
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Entity Type | Organization
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Legal Business Name | DEBORAH PETERMAN COUNSELING
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Dates
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Enumeration Date | 05/29/2009
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 1488 E GREEN BAY ST # 8
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City | SHAWANO
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State | WI
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Zip | 54166-2258
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Country | US
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Telephone | 715-524-8896
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Fax | 715-524-8964
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Provider Business Mailing Address
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Address Line | PO BOX 128
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City | SHAWANO
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State | WI
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Zip | 54166-0128
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Country | US
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Telephone | 715-524-8896
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Fax | 715-524-8964
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. DEBORAH PETERMAN
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Credential | LCSW
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Telephone | 715-524-8896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1998-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1466-057
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 189-123
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License Number State | WI
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