Donald E. Petersen, ADDICTION THERAPIST

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP00002039 Issued in WA

Practice address

1601 E 4TH Plain Blvd
Vancouver, WA 98661-3753

Phone

(360) 696-4061

Fax

(360) 750-5385

NPI assigned

Jul 18, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216339200000",
    "number": "1073778049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 E 4TH PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986613753",
            "telephone_number": "360-696-4061",
            "fax_number": "360-750-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 E 4TH PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986613753",
            "telephone_number": "360-696-4061",
            "fax_number": "360-750-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "DONALD",
        "middle_name": "E.",
        "name_prefix": "Mr.",
        "credential": "ADDICTION THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-18",
        "last_updated": "2008-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00002039",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "97-04-51",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Renee Peters, OTR/L
• Tonya Peters
• Petersen Investments, LLC
• Alina Ann Petersen, LMT
• Bryanne Petersen, BS, CDP
• Karrie Janae Petersen, MS, CCC- SLP
• Mari Petersen
• Markell Petersen, SUDP
• Tyler Daniel Petersen, D.O.
• Zoe Peterson-Lipetz

• Addiction (Substance Use Disorder) Counselor in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.