Provider Demographics
NPI:1376914622
Name:PETERSEN, LINDSEY (LPCC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3376 RIDGE GAP RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1967
Mailing Address - Country:US
Mailing Address - Phone:614-210-3654
Mailing Address - Fax:
Practice Address - Street 1:3376 RIDGE GAP RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-1967
Practice Address - Country:US
Practice Address - Phone:614-210-3654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
VA0701006246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional