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General NPI Number Information
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NPI Number | 1518010636
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Entity Type | Individual
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Provider Name | ROBERT LEE PETERSON PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 01/14/2024
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Provider Practice Location Address
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Address Line | 11198 GOOSE CREEK CIR
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City | CASPER
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State | WY
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Zip | 82609-4276
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Country | US
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Telephone | 307-267-7224
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Fax |
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Provider Business Mailing Address
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Address Line | 11198 GOOSE CREEK CIR
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City | CASPER
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State | WY
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Zip | 82609-4276
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Country | US
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Telephone | 307-267-7224
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | CSSP-18
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | CSSP-18
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License Number State | WY
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