Provider Demographics
NPI:1275806937
Name:PETERSON, DEEANN (LMFT)
Entity Type:Individual
Prefix:
First Name:DEEANN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LMFT
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 12632
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5069
Mailing Address - Country:US
Mailing Address - Phone:949-439-3880
Mailing Address - Fax:
Practice Address - Street 1:24800 CHRISANTA DR STE 210
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4842
Practice Address - Country:US
Practice Address - Phone:949-439-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41287106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist