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NPI Code Detail

MEDICARE: MR. DAVID KIM PETERSON LPC

MEDICARE: MR. DAVID KIM PETERSON LPC
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
1101YP2500XProfessional CounselorP8904003AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25T108OTHERARBLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number : 1497725899
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID KIM PETERSON LPC
Provider Business Mailing Address
First Line : 125 DONS WAY
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71913
Country : US
Telephone Number : 501-620-5130
Fax Number : 501-620-5109
Provider Business Practice Location Address
First Line : 125 DONS WAY
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71913-3423
Country : US
Telephone Number : 501-624-7111
Fax Number : 501-620-5109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 12/19/2008

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