Provider Demographics
NPI:1598807760
Name:PETERSON, DANIELA F (LPC)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:F
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 1:825 HI COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-9442
Mailing Address - Country:US
Mailing Address - Phone:307-413-6528
Mailing Address - Fax:
Practice Address - Street 1:140 E BROADWAY AVE STE B-13
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8632
Practice Address - Country:US
Practice Address - Phone:307-413-6528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor