Provider Demographics
NPI:1619084555
Name:PETERSON, JAIME CHRISTINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:CHRISTINE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W. DRAKE RD, SUITE 270
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526
Mailing Address - Country:US
Mailing Address - Phone:970-305-5822
Mailing Address - Fax:970-286-2906
Practice Address - Street 1:333 W. DRAKE RD, SUITE 270
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526
Practice Address - Country:US
Practice Address - Phone:970-305-5822
Practice Address - Fax:970-286-2906
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099235031041C0700X
COCSW09923503103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling