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General NPI Number Information
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NPI Number | 1518356484
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Entity Type | Organization
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Legal Business Name | PETERSEN ENTERPRISES INC
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 4529 STOVER ST
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City | FORT COLLINS
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State | CO
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Zip | 80525-3261
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Country | US
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Telephone | 970-234-1147
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Fax |
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Provider Business Mailing Address
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Address Line | 4213 DURANGO PL
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City | FORT COLLINS
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State | CO
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Zip | 80526-4103
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Country | US
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Telephone | 970-234-1147
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JENNIFER PETERSEN
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Credential | MA, LPC
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Telephone | 970-234-1147
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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 | 2179
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License Number State | CO
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