Provider Demographics
NPI:1891389847
Name:DANNA M. PETERSON, LPC, CMHC, PLLC
Entity Type:Organization
Organization Name:DANNA M. PETERSON, LPC, CMHC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:602-510-0665
Mailing Address - Street 1:2252 KINGMAN AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4838
Mailing Address - Country:US
Mailing Address - Phone:602-510-0665
Mailing Address - Fax:765-227-4798
Practice Address - Street 1:2252 KINGMAN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4838
Practice Address - Country:US
Practice Address - Phone:602-510-0665
Practice Address - Fax:765-227-4798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty