Provider Demographics
NPI:1811166937
Name:PETERSON, SCOTT H (LMHC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:H
Last Name:PETERSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1258
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46015-1258
Mailing Address - Country:US
Mailing Address - Phone:765-649-8161
Mailing Address - Fax:765-641-8350
Practice Address - Street 1:2020 BROWN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4218
Practice Address - Country:US
Practice Address - Phone:765-649-8161
Practice Address - Fax:765-641-8350
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001409A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health