Provider Demographics
NPI:1265902118
Name:PETERMAN, ANITA KAY (MS, LPC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:KAY
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5336 KEWLEY LN
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-8463
Mailing Address - Country:US
Mailing Address - Phone:785-532-9693
Mailing Address - Fax:
Practice Address - Street 1:5336 KEWLEY LN
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-8463
Practice Address - Country:US
Practice Address - Phone:785-532-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2755101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
14284866OtherCAQH
KS2755OtherBEHAVIORAL SCIENCES REGULATORY BOARD