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General NPI Number Information
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NPI Number | 1366035834
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Entity Type | Individual
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Provider Name | JUSTIN PETERSON LPCC
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Gender | Male
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 4004 CARLISLE BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-4565
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Country | US
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Telephone | 505-270-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 304 HOMELAND RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-1614
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CTB20250426
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CTB-2023-0133
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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