Calleen Patricia Petersen, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

M11232 Issued in MS

Practice address

6858 Swinnea Rd BLDG Ste 7
Southaven, MS 38671-9493

Phone

(662) 536-6210

Fax

(662) 510-8820

NPI assigned

Oct 16, 2024

Sex

Female

Sole proprietor

No

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

State licenses

Practice roles

Locations

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.

• Hec Medical

  • Psychiatric/Mental Health Nurse Practitioner
  • Southaven, MS
  • NPI 1922818467
  NPD

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

{
    "created_epoch": "1729036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1194545863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6858 SWINNEA RD BLDG STE 7",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719493",
            "telephone_number": "662-536-6210",
            "fax_number": "662-510-8820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6858 SWINNEA RD BLDG STE 7",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719493",
            "telephone_number": "662-536-6210",
            "fax_number": "662-510-8820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "CALLEEN",
        "middle_name": "PATRICIA",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-16",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MS",
            "license": "M11232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie B Pearson, NP
• Turner Donaldson Peckham
• Airreal Pegues, MS
• Madison Grace Pena, PTA
• Jennifer Petell, PH.D IN CLINICAL PSY
• John S Petrides
• Tracey F Petrides, M.D.
• Blanche Foshee' Petty, APRN
• Pharmcare USA of Memphis, Inc
• Phase2 Labs Mississippi LLC

• Social Worker in Southaven, MS
• Providers in Southaven, MS by specialty
• Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.