Provider Demographics
NPI:1619353562
Name:PETERSEN, RITA J (LPC, NCC, ACS)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:J
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8462 ARTESIAN SPRINGS PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4725
Mailing Address - Country:US
Mailing Address - Phone:720-608-1603
Mailing Address - Fax:
Practice Address - Street 1:7345 ADVENTURE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-5000
Practice Address - Country:US
Practice Address - Phone:720-608-1603
Practice Address - Fax:719-960-2334
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013826101Y00000X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional