MEDICARE: THERESA ANN PETERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1245184688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA ANN PETERSON

Provider Business Mailing Address
First Line	:	2660 NE HIGHWAY 20 STE 610
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6403
Country	:	US
Telephone Number	:	910-388-7958
Fax Number	:

Provider Business Practice Location Address
First Line	:	2660 NE HIGHWAY 20 STE 610
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6403
Country	:	US
Telephone Number	:	910-388-7958
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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Directions to “ THERESA ANN PETERSON ” Practice Location

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