Provider Demographics
NPI:1023227238
Name:PETERSON, COLLEEN MARGARET (PHD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MARGARET
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1796 BAJA LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3108
Mailing Address - Country:US
Mailing Address - Phone:702-269-5781
Mailing Address - Fax:702-895-4797
Practice Address - Street 1:4505 S MARYLAND PKWY
Practice Address - Street 2:BOX 453047
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89154-9900
Practice Address - Country:US
Practice Address - Phone:702-895-4798
Practice Address - Fax:702-895-4797
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0850106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist