Peterson, Gary Robert

Peterson, Gary Robert is an individual health care provider with primary practice located at 1538 The Greens Way Ste 101 , Jacksonville Beach FL 32250-1400. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Peterson, Gary Robert can be contacted via phone (904) 543-0161.

Contact Information

Primary practice address
1538 The Greens Way Ste 101 Jacksonville Beach FL 32250-1400
Phone: (904) 543-0161
Fax: (904) 543-9172
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH0001443 Florida

Profile Details

NPI number 1164589610
LBN Legal business name Peterson, Gary Robert
Credentials MA,LMHC,CEAP,SAP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 3rd, 2007
Last updated Jul 8th, 2007 - about 17 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 1164589610 NPPES
Florida Other MH0001443 LIC MENTAL HEALTH COU

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