Petersen, Judeth

Petersen, Judeth is an individual health care provider with primary practice located at 501 S Burma Ave , Gillette WY 82716-3426. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Counselor. Behavioral Health & Social Service Providers / Counselor is her primary health care specialty. Petersen, Judeth can be contacted via phone (307) 688-5000.

Contact Information

Primary practice address
501 S Burma Ave Gillette WY 82716-3426
Phone: (307) 688-5000
Fax: (307) 688-5015
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 1512 North Dakota
Behavioral Health & Social Service Providers / Counselor 101Y00000X LPC-1129 Wyoming

Profile Details

NPI number 1033263652
LBN Legal business name Petersen, Judeth
Credentials M.A., LPC
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 22nd, 2007
Last updated Aug 25th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033263652 NPPES
Wyoming Other LPC-1129 STATE OF WYOMING MENTAL HEALTH PROFESSIONS LICENSING BOARD

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