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General NPI Number Information
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NPI Number | 1346889227
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Entity Type | Organization
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Legal Business Name | JAYSON PETERSON, MED, LMFT, LLC
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Dates
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Enumeration Date | 12/24/2019
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Last Update Date | 12/24/2019
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Provider Practice Location Address
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Address Line | 42 W 25TH AVE
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City | EUGENE
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State | OR
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Zip | 97405-3137
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Country | US
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Telephone | 541-513-5391
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Fax |
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Provider Business Mailing Address
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Address Line | 4640 LEONA CT
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City | EUGENE
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State | OR
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Zip | 97402-1224
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Country | US
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Telephone | 541-513-5391
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAYSON PETERSON
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Credential | LMFT
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Telephone | 541-513-5391
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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 |
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