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NPI Code Detail

MEDICARE: JENNIFER RAE PETERS M.A.

MEDICARE: JENNIFER RAE PETERS M.A.
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
1101YM0800XMental Health CounselorLPC-MH2198SD
2101YP2500XProfessional CounselorLPC1184SD
3101YM0800XMental Health CounselorCC00139MN

General Provider Information

NPI Number : 1649598228
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER RAE PETERS M.A.
Provider Business Mailing Address
First Line : 528 QUINCY ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-3628
Country : US
Telephone Number : 605-517-2005
Fax Number :
Provider Business Practice Location Address
First Line : 528 QUINCY ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-3628
Country : US
Telephone Number : 605-517-2005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2010
Last Update Date : 10/09/2025

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