Wayne Douglas Peterson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3690346004 Issued in UT

Practice address

164 N Main St
(Rear)
Richfield, UT 84701-2170

Phone

(435) 201-4481

NPI assigned

Feb 13, 2007

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

Other identifiers 2

Other names 1

• Mr. Douglas Peterson Professional name

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": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124160262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 662",
            "city": "RICHFIELD",
            "state": "UT",
            "postal_code": "847010662",
            "telephone_number": "435-201-4481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 N MAIN ST",
            "address_2": "(REAR)",
            "city": "RICHFIELD",
            "state": "UT",
            "postal_code": "847012170",
            "telephone_number": "435-201-4481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "WAYNE",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "UT",
            "license": "3690346004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE CROSS BLUE S",
            "identifier": "36903460000001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "86695",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOUGLAS",
            "last_name": "PETERSON",
            "prefix": "MR.",
            "credential": "LPC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Rebekah Amy Patterson, FNP
• Joshua Peeks
• Joshua Michael Penman
• Iris Peterson
• Khristine Anastasia Peterson
• Avery Pettit
• Holly Pipes, SSW, MSW STUDENT
• David M Pope, MD
• Positive Presence Training Solutions, LLC.
• Prohealth Braces

• Professional Counselor in Richfield, UT
• Providers in Richfield, UT by specialty
• Professional Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.