Active NPI
Zinaida Petersen
- Mental Health Counselor
- Indianapolis, IN
National Provider Identifier
1376371237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 39004987A
- Practice address
- 6067 Decatur Blvd
Indianapolis, IN 46241-9606 - Phone
- (317) 856-5201
- NPI assigned
- Jul 23, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 39004987A | IN | Primary |
Addresses
Primary practice location
6067 Decatur Blvd
Indianapolis, IN 46241-9606
Mailing address
6651 Buckhorn Dr
Indianapolis, IN 46254-5271
Phone (202) 285-5751
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 |
|---|---|---|---|
| 39004987A | IN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721779200000",
"number": "1376371237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6651 BUCKHORN DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462545271",
"telephone_number": "202-285-5751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6067 DECATUR BLVD",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462419606",
"telephone_number": "317-856-5201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "ZINAIDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-23",
"last_updated": "2024-07-24",
"certification_date": "2024-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39004987A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.