MEDICARE: JEFF PETERSON L.P.C., L.C.P.C.

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	101YM0800X	Mental Health Counselor	101101	IA
2	101YM0800X	Mental Health Counselor	2448	NE
3	101YM0800X	Mental Health Counselor	30907	SD

General Provider Information

NPI Number	:	1386069565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF PETERSON L.P.C., L.C.P.C.

Provider Business Mailing Address
First Line	:	211 SIOUX POINT RD STE 300
Second Line	:
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5492
Country	:	US
Telephone Number	:	605-215-6695
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 SIOUX POINT RD STE 300
Second Line	:
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5492
Country	:	US
Telephone Number	:	605-215-6695
Fax Number	:

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

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	02/03/2025

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Directions to “ JEFF PETERSON L.P.C., L.C.P.C.” Practice Location

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