Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 880 | SC |
Y | 103TC0700X | Clinical Psychologist | 880 | SC |
N | 102L00000X | Psychologist | 880 | SC |
N | 103T00000X | Psychologist | 880 | SC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 880 | SC |
N | 103G00000X | Clinical Psychologist | 880 | SC |
N | 103TC0700X | Clinical Psychologist | 880 | SC |
N | 103TH0100X | Health Service | 880 | SC |
N | 103TP2701X | Group Psychotherapist | 880 | SC |
N | 103TR0400X | Rehabilitation Psychologist | 880 | SC |
NPI | 1548312549 |
---|---|
Provider Name | Randolph Scott Petersen |
First Address | Murfreesboro, TN 37129-1392 |
Second Address | Murfreesboro, TN 37129-1392 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 29/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PS0384 | (05) | SC |
Q33747 | (02) | SC |