Provider Demographics
NPI:1114996139
Name:PETERMANN, CHANDA ELIZABETH (LMHC)
Entity Type:Individual
Prefix:MS
First Name:CHANDA
Middle Name:ELIZABETH
Last Name:PETERMANN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-3502
Mailing Address - Country:US
Mailing Address - Phone:515-267-1003
Mailing Address - Fax:515-267-0100
Practice Address - Street 1:1003 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3502
Practice Address - Country:US
Practice Address - Phone:515-267-1003
Practice Address - Fax:515-267-0100
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA354101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1045898Medicaid
IAIA0119OtherJOHN DEERE HC
IA1045898OtherMERIT BH