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General NPI Number Information
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NPI Number | 1619028651
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Entity Type | Individual
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Provider Name | CHANDRA PETERSEN LMHP, LADC
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 1654 WASHINGTON ST
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City | BLAIR
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State | NE
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Zip | 68008-1656
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Country | US
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Telephone | 402-533-3680
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Fax | 402-478-5047
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Provider Business Mailing Address
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Address Line | PO BOX 589
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City | BLAIR
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State | NE
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Zip | 68008-0589
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Country | US
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Telephone | 402-533-3680
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2997
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 731
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License Number State | NE
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