Provider Demographics
NPI:1811546252
Name:PETERSON, LAURA JO (LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JO
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 1:3636 HEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1721
Mailing Address - Country:US
Mailing Address - Phone:614-286-8313
Mailing Address - Fax:
Practice Address - Street 1:299 CRAMER CREEK CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2586
Practice Address - Country:US
Practice Address - Phone:614-889-5722
Practice Address - Fax:614-889-9335
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700512101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional