Carolyn Alisa Peterson, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3197 Issued in OR

Practice address

4039 N Mississippi Ave Ste 307
Portland, OR 97227-1477

Phone

(971) 402-9705

NPI assigned

Mar 18, 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

Opted out of Medicare

Previously, effective Aug 5, 2024 through Aug 5, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

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.

• Arun Wellness and Psychological Services, LLC

  • Adult Mental Health Clinic/Center
  • Portland, OR
  • NPI 1407696727
  NPD Authorized official

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737763200000",
    "number": "1386403863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4039 N MISSISSIPPI AVE STE 307",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271477",
            "telephone_number": "971-402-9705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4039 N MISSISSIPPI AVE STE 307",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271477",
            "telephone_number": "971-402-9705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CAROLYN",
        "middle_name": "ALISA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-18",
        "last_updated": "2025-01-25",
        "certification_date": "2025-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "3197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Irene Peterson, N.D.
• Autumn Leah Peterson, L.M.T
• Bennett Grey Peterson
• Beverly Ann Peterson
• Caroline Deanne Peterson, DC
• Carolyn M Peterson, MD
• Cheryl Marie Peterson
• Christina Peterson, PHARMD
• Cory Peterson, DC
• Curtis Scott Peterson, MSW

• Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.