Provider Demographics
NPI:1912182981
Name:PETERSON, CHRISTINE E (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:E
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N ROCK RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2203
Mailing Address - Country:US
Mailing Address - Phone:316-295-4756
Mailing Address - Fax:316-295-4750
Practice Address - Street 1:250 N ROCK RD
Practice Address - Street 2:SUITE 130
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2203
Practice Address - Country:US
Practice Address - Phone:316-295-4756
Practice Address - Fax:316-295-4750
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMFT 917106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist