Provider Demographics
NPI:1720185416
Name:PETERSON, PATTI K (LPC)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:K
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 1:3610 NW BLUE JACKET DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-3012
Mailing Address - Country:US
Mailing Address - Phone:816-510-1172
Mailing Address - Fax:816-373-1128
Practice Address - Street 1:3610 NW BLUE JACKET DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-3012
Practice Address - Country:US
Practice Address - Phone:816-510-1172
Practice Address - Fax:816-373-1128
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002238101YP2500X
KS157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional