Active NPI
Edward J Peterson
- Marriage & Family Therapist
- Apple Valley, CA
National Provider Identifier
1326179466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 87914
- Practice address
- 17800 US Highway 18
Apple Valley, CA 92307-1221 - Phone
- (760) 946-8200
- Fax
- (760) 946-8208
- NPI assigned
- Mar 8, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 43011 | CA | |
| Marriage & Family Therapist | 106H00000X | 87914 | CA | Primary |
Addresses
Primary practice location
17800 US Highway 18
Apple Valley, CA 92307-1221
Mailing address
17800 US Highway 18
Apple Valley, CA 92307-1221
Phone (760) 946-8200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43011 | Other | CA | IMF |
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 |
|---|---|---|---|
| 43011 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525651200000",
"number": "1326179466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17800 US HIGHWAY 18",
"city": "APPLE VALLEY",
"state": "CA",
"postal_code": "923071221",
"telephone_number": "760-946-8200",
"fax_number": "760-946-8208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17800 US HIGHWAY 18",
"city": "APPLE VALLEY",
"state": "CA",
"postal_code": "923071221",
"telephone_number": "760-946-8200",
"fax_number": "760-946-8208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "EDWARD",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-08",
"last_updated": "2018-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "43011",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "87914",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IMF",
"identifier": "43011",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Apple Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.