Provider Demographics
NPI:1649718305
Name:PETERSEN, TARYN (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:
Other - Last Name:SOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-0288
Mailing Address - Country:US
Mailing Address - Phone:570-620-4311
Mailing Address - Fax:570-620-4332
Practice Address - Street 1:105 TERRACE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7510
Practice Address - Country:US
Practice Address - Phone:570-620-4311
Practice Address - Fax:570-620-4332
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional