Active NPI
Linton Petersen
- Counselor
- Forks, WA
National Provider Identifier
1124424957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CG60415963
- Practice address
- 530 Bogachiel Way
Forks, WA 98331-9120 - Phone
- (360) 374-5011
- Fax
- (360) 374-6691
- NPI assigned
- Nov 5, 2014
- Last updated
- Nov 5, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG60415963 | WA | Primary |
Addresses
Primary practice location
530 Bogachiel Way
Forks, WA 98331-9120
Mailing address
530 Bogachiel Way
Forks, WA 98331-9120
Phone (360) 374-5011
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60415963 | WA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415145600000",
"number": "1124424957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 BOGACHIEL WAY",
"city": "FORKS",
"state": "WA",
"postal_code": "983319120",
"telephone_number": "360-374-5011",
"fax_number": "360-374-6691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 BOGACHIEL WAY",
"city": "FORKS",
"state": "WA",
"postal_code": "983319120",
"telephone_number": "360-374-5011",
"fax_number": "360-374-6691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "LINTON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-11-05",
"last_updated": "2014-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG60415963",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forks, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.