Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 2010009686 | MO |
N | 101YP2500X | Professional Counselor | 2010009686 | MO |
N | 101YS0200X | School Counselor | 0455347 | MO |
NPI | 1174848014 |
---|---|
Provider Name | Dr. Linda F Peterson |
First Address | O Fallon, MO 63366-1889 |
Second Address | Maryland Heights, MO 63043-2729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2010 |
Last Update Date | 12/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
49296908 | (05) | MO |