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NPI Code Detail

MEDICARE: TARYN PETERSEN MA, LPC, NCC

MEDICARE: TARYN PETERSEN MA, LPC, NCC
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 CounselorPC009331PA

General Provider Information

NPI Number : 1649718305
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARYN PETERSEN MA, LPC, NCC
Provider Business Mailing Address
First Line : PO BOX 288
Second Line :
City : STROUDSBURG
State : PA
Zip : 18360-0288
Country : US
Telephone Number : 570-620-4311
Fax Number : 570-620-4332
Provider Business Practice Location Address
First Line : 105 TERRACE DR
Second Line : SUITE 102
City : STROUDSBURG
State : PA
Zip : 18360-7510
Country : US
Telephone Number : 570-620-4311
Fax Number : 570-620-4332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2017
Last Update Date : 02/16/2017

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