Provider Demographics
NPI:1083231153
Name:PETERSON, KERRI (PLMHP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 K ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2960
Mailing Address - Country:US
Mailing Address - Phone:402-474-0011
Mailing Address - Fax:402-474-0012
Practice Address - Street 1:815 K ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2960
Practice Address - Country:US
Practice Address - Phone:402-474-0011
Practice Address - Fax:402-474-0012
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12275101YM0800X
NE7499104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker