Provider Demographics
NPI:1164730396
Name:PETERSON COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:PETERSON COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-221-6070
Mailing Address - Street 1:745 OLIVE ST
Mailing Address - Street 2:SUITE 109B
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2246
Mailing Address - Country:US
Mailing Address - Phone:318-221-6070
Mailing Address - Fax:318-221-6069
Practice Address - Street 1:745 OLIVE ST
Practice Address - Street 2:SUITE 109B
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2246
Practice Address - Country:US
Practice Address - Phone:318-221-6070
Practice Address - Fax:318-221-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty