Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC.0012435 | CO |
NPI | 1003060302 |
---|---|
Provider Name | Mr. Erik Jon Petersen |
First Address | Denver, CO 80247-1314 |
Second Address | Highlands Ranch, CO 80129-2333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2008 |
Last Update Date | 14/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
026708 | KAISER COMMERCIAL NUMBER (01) | CO |
84054212 | (05) | CO |