Provider Demographics
NPI:1831512524
Name:PETERSON, SUSAN DENISE (LMFT, LMHC,NCC,CSAC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DENISE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LMFT, LMHC,NCC,CSAC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:DENISE
Other - Last Name:MEYER, BROTHERTON, FOSHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-0094
Mailing Address - Country:US
Mailing Address - Phone:808-636-1649
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVENUE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-2130
Practice Address - Country:US
Practice Address - Phone:253-967-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1674-12101YA0400X
HIMHC 309101YM0800X
HIMFT 369106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health