Provider Demographics
NPI:1841381332
Name:PETERSEN, RICHARD M (LMFT MAC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:LMFT MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAMEDDAC WUERZBURG, UNIT 26610
Mailing Address - Street 2:ATTN: CREDENTIALS OFFICE
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244
Mailing Address - Country:DE
Mailing Address - Phone:0114993-184-3616
Mailing Address - Fax:01149931-804-3241
Practice Address - Street 1:USAMEDDAC WUERZBURG, ANSBACH MIDDLE HIGH SCHOOL
Practice Address - Street 2:
Practice Address - City:ANSBACH
Practice Address - State:GERMANY
Practice Address - Zip Code:09177
Practice Address - Country:DE
Practice Address - Phone:0980-283-2153
Practice Address - Fax:09-802-1496
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB23678101YA0400X
CA#36434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN