Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 394165 | NM |
NPI | 1003577164 |
---|---|
Provider Name | Lisa S Peterson |
First Address | Las Cruces, NM 88001-1243 |
Second Address | Las Cruces, NM 88001-1243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2021 |
Last Update Date | 31/12/2021 |