Gary Robert Peterson, MA,LMHC,CEAP,SAP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH0001443 Issued in FL

Practice address

1538 The Greens Way Ste 101
Jacksonville Beach, FL 32250-1400

Phone

(904) 543-0161

Fax

(904) 543-9172

NPI assigned

Jan 3, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marsh Landing Behavioral Group Inc

  • Child & Adolescent Psychiatry Physician
  • Jacksonville Beach, FL
  • NPI 1124143490
  NPD (past)

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164589610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1538 THE GREENS WAY STE 101",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322501400",
            "telephone_number": "904-543-0161",
            "fax_number": "904-543-9172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1538 THE GREENS WAY STE 101",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322501400",
            "telephone_number": "904-543-0161",
            "fax_number": "904-543-9172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "GARY",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "MA,LMHC,CEAP,SAP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH0001443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC MENTAL HEALTH COU",
            "identifier": "MH0001443",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron Percoco, RMHCI
• Performance Physical Medicine and Rehab
• Laura R Peter, D.O.
• Madison Harris Petersen, NP
• Ashley Megan Peterson, LMT
• Jessica Phillips, IBCLC
• Wendy Colleen Phou, M.S., CF-SLP
• Physicians Group Services PA
• Samantha Pierce
• Kenneth Arthur Piering, D.C.

• Mental Health Counselor in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Mental Health Counselor in Florida

• 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.