Provider Demographics
NPI:1568815074
Name:PETERSEN, NANCY JUNE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JUNE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 E G ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-2518
Mailing Address - Country:US
Mailing Address - Phone:308-637-2062
Mailing Address - Fax:
Practice Address - Street 1:1419 MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-3340
Practice Address - Country:US
Practice Address - Phone:307-532-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1579101Y00000X
SD20687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDLPC20687OtherSOUTH DAKOTA BOARD OF EXAMINERS FOR COUNSELORS & MARRIAGE & FAMILY THERAPISTS
WY1579OtherWYOMING MENTAL HEALTH PROFESSIONS LICENSING BOARD