MEDICARE: PETERSON COUNSELING & CONSULTING, INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1376018499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSON COUNSELING & CONSULTING, INC.

Provider Business Mailing Address
First Line	:	8522 CREEDMOOR LN
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-4620
Country	:	US
Telephone Number	:	727-753-8082
Fax Number	:

Provider Business Practice Location Address
First Line	:	8522 CREEDMOOR LN
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-4620
Country	:	US
Telephone Number	:	727-753-8082
Fax Number	:

Authorized Official
Title or Position	:	EMPLOYEE
Name	:	RITA MARIE CHENOWETH PETERSON
Credential	:	LCSW
Telephone Number	:	727-753-8082

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	10/04/2018

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