Provider Demographics
NPI:1003282559
Name:PETERSON, ANNE TAYLOR (LPA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:TAYLOR
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 LEHMAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-6515
Mailing Address - Country:US
Mailing Address - Phone:270-393-9834
Mailing Address - Fax:270-393-9835
Practice Address - Street 1:1011 LEHMAN AVE STE 103
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6515
Practice Address - Country:US
Practice Address - Phone:270-393-9834
Practice Address - Fax:270-393-9835
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPSYPAT 00218866103T00000X
KY166069103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist