Active NPI
Judeth Petersen, M.A., LPC
- Counselor
- Gillette, WY
National Provider Identifier
1033263652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LPC-1129
- Practice address
- 501 S Burma Ave
Gillette, WY 82716-3426 - Phone
- (307) 688-5000
- Fax
- (307) 688-5015
- NPI assigned
- Jan 22, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1512 | ND | |
| Counselor | 101Y00000X | LPC-1129 | WY | Primary |
Addresses
Primary practice location
501 S Burma Ave
Gillette, WY 82716-3426
Mailing address
501 S Burma Ave
Gillette, WY 82716-3426
Phone (307) 688-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LPC-1129 | Other | WY | STATE OF WYOMING MENTAL HEALTH PROFESSIONS LICENSING BOARD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-1129 | WY | MD | Counselor |
| 1512 | ND | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314230400000",
"number": "1033263652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 S BURMA AVE",
"city": "GILLETTE",
"state": "WY",
"postal_code": "827163426",
"telephone_number": "307-688-5000",
"fax_number": "307-688-5015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 S BURMA AVE",
"city": "GILLETTE",
"state": "WY",
"postal_code": "827163426",
"telephone_number": "307-688-5000",
"fax_number": "307-688-5015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "JUDETH",
"name_prefix": "Ms.",
"credential": "M.A., LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-22",
"last_updated": "2011-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "ND",
"license": "1512",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WY",
"license": "LPC-1129",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF WYOMING MENTAL HEALTH PROFESSIONS LICENSING BOARD",
"identifier": "LPC-1129",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gillette, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.