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General NPI Number Information
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NPI Number | 1396983128
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Entity Type | Organization
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Legal Business Name | JON PETERSON PSYCHOLOGIST PHD PC
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 25401 CABOT RD SUITE 213
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5524
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Country | US
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Telephone | 949-363-7386
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Fax | 949-276-2199
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Provider Business Mailing Address
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Address Line | 25401 CABOT RD SUITE 213
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5524
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Country | US
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Telephone | 949-363-7386
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Fax | 949-276-2199
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Authorized Official
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Title or Position | OWNER
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Name | DR. JON W PETERSON
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Credential | PH.D.
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Telephone | 949-363-7386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | PSY6987
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License Number State | CA
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