Provider Demographics
NPI:1679939482
Name:PETERSON, SUMMER J (LCPC, LMFT)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:J
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LCPC, LMFT
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 21002
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-1002
Mailing Address - Country:US
Mailing Address - Phone:406-425-4508
Mailing Address - Fax:
Practice Address - Street 1:2020 GRAND AVE STE 8
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2615
Practice Address - Country:US
Practice Address - Phone:406-425-4508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health