Active NPI
Trevor J Petersen, PHD, LCP
- Clinical Psychologist
- Klamath Falls, OR
National Provider Identifier
1326719295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2913
- Practice address
- 905 Main St Ste 200a
Klamath Falls, OR 97601-6066 - Phone
- (541) 205-9218
- NPI assigned
- Sep 21, 2021
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2913 | OR | Primary |
Addresses
Primary practice location
905 Main St Ste 200a
Klamath Falls, OR 97601-6066
Mailing address
905 Main St Ste 200a
Klamath Falls, OR 97601-6066
Phone (541) 205-9218
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2913 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700438400000",
"number": "1326719295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "905 MAIN ST STE 200A",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976016066",
"telephone_number": "541-205-9218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905 MAIN ST STE 200A",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976016066",
"telephone_number": "541-205-9218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "TREVOR",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PHD, LCP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-21",
"last_updated": "2023-11-20",
"certification_date": "2023-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Klamath Falls, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.