Provider Demographics
NPI:1265637201
Name:PETERSON, KENYA (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:KENYA
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-0839
Mailing Address - Country:US
Mailing Address - Phone:662-287-4424
Mailing Address - Fax:662-286-2070
Practice Address - Street 1:601 FOOTE ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-4834
Practice Address - Country:US
Practice Address - Phone:662-287-4424
Practice Address - Fax:662-286-2070
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health