David Jordan Peterson, MS, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A2304006 Issued in AR

Practice address

109 N 48TH St
Springdale, AR 72762-3743

Phone

(479) 222-0269

NPI assigned

Jun 22, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1687392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1093491417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 W STONEY BROOK RD APT 9106",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727584649",
            "telephone_number": "903-571-8955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N 48TH ST",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727623743",
            "telephone_number": "479-222-0269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DAVID",
        "middle_name": "JORDAN",
        "credential": "MS, LAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-22",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A2304006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Dawn Perryman
• Joanna B Person-Michener, LPC
• Kimberly Diane Person, RN
• Susan Deola Peter, LCSW
• Angela Renee Peters, LPC
• Nicole Emily Peterson, LMSW
• Makenzie Jo Petrin
• Robert A Petrino, M.D.
• Lily Jo Pettypiece
• Jacob Paul Phaneuf, MHPP

• Mental Health Counselor in Springdale, AR
• Providers in Springdale, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; 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.