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General NPI Number Information
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NPI Number | 1992259519
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Entity Type | Individual
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Provider Name | STACY PETERSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 117 PARK DR S STE A
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City | GREAT FALLS
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State | MT
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Zip | 59401-3612
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Country | US
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Telephone | 406-781-4973
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Fax | 406-403-0222
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Provider Business Mailing Address
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Address Line | PO BOX 2851
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City | GREAT FALLS
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State | MT
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Zip | 59403-2851
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Country | US
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Telephone | 406-781-4973
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Fax | 406-403-0222
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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 | 18900
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License Number State | MT
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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 | 18900
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 18900
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License Number State | MT
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