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General NPI Number Information
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NPI Number | 1831512524
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Entity Type | Individual
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Provider Name | SUSAN DENISE PETERSON LMFT, LMHC,NCC,CSAC
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Gender | Female
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVENUE
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City | TACOMA
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State | WA
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Zip | 98431-2130
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Country | US
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Telephone | 253-967-2712
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 94
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City | GRAHAM
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State | WA
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Zip | 98338-0094
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Country | US
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Telephone | 808-636-1649
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1674-12
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MHC 309
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT 369
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License Number State | HI
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