Provider Demographics
NPI:1497823215
Name:PETERSON, ELIZABETH HARRIS (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:HARRIS
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 CASPIANA LN
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-9601
Mailing Address - Country:US
Mailing Address - Phone:318-741-0614
Mailing Address - Fax:
Practice Address - Street 1:5845 CASPIANA LN
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-9601
Practice Address - Country:US
Practice Address - Phone:318-741-0614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional