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General NPI Number Information
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NPI Number | 1407667843
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Entity Type | Individual
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Provider Name | CHRISTY LEE PETERSON
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Gender | Female
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 5796 S 900 E
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City | MURRAY
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State | UT
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Zip | 84121-1036
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Country | US
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Telephone | 385-436-2075
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Fax |
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Provider Business Mailing Address
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Address Line | 1393 E ZENITH AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-3425
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Country | US
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Telephone | 801-419-4946
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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 | 14199209-3904
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License Number State | UT
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