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General NPI Number Information
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NPI Number | 1427419993
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Entity Type | Individual
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Provider Name | KRISTINA PETERSON PH.D., NCC, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/11/2016
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 115 N MARION ST SUITE 1
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City | OAK PARK
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State | IL
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Zip | 60301-1503
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Country | US
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Telephone | 708-834-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 4455 S LEAMINGTON AVE
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City | CHICAGO
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State | IL
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Zip | 60638-1910
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Country | US
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Telephone | 312-371-6807
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.011641
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License Number State | IL
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