Peterson, Nathan Mark

Peterson, Nathan Mark is an sole proprietor health care provider with primary practice located at 1459 N Main St , Bountiful UT 84010-6092. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Peterson, Nathan Mark can be contacted via phone (801) 298-2000.

Contact Information

Primary practice address
1459 N Main St Bountiful UT 84010-6092
Phone: (801) 298-2000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 7350613-3501 Utah
Behavioral Health & Social Service Providers / Professional 101YP2500X 7350613-3501 Utah

Profile Details

NPI number 1447534268
LBN Legal business name Peterson, Nathan Mark
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 29th, 2011
Last updated Nov 28th, 2016 - about 8 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 1447534268 NPPES
Utah MEDICAID 876000308007
Utah Other 260022408

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