Provider Demographics
NPI:1205448065
Name:PETTERSON, CASEY LIANE (LPC)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:LIANE
Last Name:PETTERSON
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 1:6399 S SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2912
Mailing Address - Country:US
Mailing Address - Phone:316-304-3657
Mailing Address - Fax:
Practice Address - Street 1:6399 S SANTA FE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2912
Practice Address - Country:US
Practice Address - Phone:316-304-3657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0018622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPC.0018622OtherDEPARTMENT OF REGULATORY AGENCIES
CO20221898057OtherSECRETARY OF STATE