Provider Demographics
NPI:1558832410
Name:PETERSON, JOCELYN (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LMFT, 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 5032
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-0032
Mailing Address - Country:US
Mailing Address - Phone:479-586-7712
Mailing Address - Fax:
Practice Address - Street 1:17 FOLKINGHAM LN
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-3042
Practice Address - Country:US
Practice Address - Phone:479-586-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM1706022106H00000X
ARP1612199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist