Provider Demographics
NPI:1659984037
Name:PETERSEN, BRITTANY J (LMFT, LPC, CMHC)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:J
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LMFT, LPC, CMHC
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:J
Other - Last Name:AYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:470 W 200 N UNIT 131
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1692
Mailing Address - Country:US
Mailing Address - Phone:417-214-3158
Mailing Address - Fax:
Practice Address - Street 1:470 W 200 N UNIT 131
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-1692
Practice Address - Country:US
Practice Address - Phone:417-214-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13755821-6004101YM0800X
MO2020028432101YP2500X
MO202002768106H00000X
UT13755821-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional