Provider Demographics
NPI:1649653718
Name:PAULA M PETERSON
Entity type:Organization
Organization Name:PAULA M PETERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:MARIE JEANNETTE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP
Authorized Official - Phone:402-833-1410
Mailing Address - Street 1:803 PROVIDENCE RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-1519
Mailing Address - Country:US
Mailing Address - Phone:402-833-1410
Mailing Address - Fax:
Practice Address - Street 1:803 PROVIDENCE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1623
Practice Address - Country:US
Practice Address - Phone:402-833-1410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty