MEDICARE: TERESA PETERSON APCC

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	8637	CA

General Provider Information

NPI Number	:	1457923450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA PETERSON APCC

Provider Business Mailing Address
First Line	:	115 W PLAZA ST STE 200
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-1123
Country	:	US
Telephone Number	:	619-503-7731
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 W PLAZA ST STE 200
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-1123
Country	:	US
Telephone Number	:	619-503-7731
Fax Number	:

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

Provider Enumeration Date	:	07/11/2021
Last Update Date	:	07/11/2021

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Directions to “ TERESA PETERSON APCC” Practice Location

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