Mark Paul Pettersen, MA LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

178.01669 Issued in IL

Practice address

2010 E Algonquin Rd
Schaumburg, IL 60173-4185

Phone

(847) 359-5192

NPI assigned

May 26, 2016

Sex

Male

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

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1464220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464220800000",
    "number": "1477901700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "973 N ARROWHEAD DR",
            "city": "PALATINE",
            "state": "IL",
            "postal_code": "600743701",
            "telephone_number": "224-425-0716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 E ALGONQUIN RD",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734185",
            "telephone_number": "847-359-5192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERSEN",
        "first_name": "MARK",
        "middle_name": "PAUL",
        "credential": "MA LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-26",
        "last_updated": "2016-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.01669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Petersen, MS CCC SLP
• Melissa Petersohn, O.D.
• Bruce B Peterson, O.D.
• Danielle Marie Peterson
• Gabriela Daniel Petrova
• Mylinh Thi Pham, PHARMD
• Pharmed Inc
• Logan Phengsomphone, RBT
• Cheryl Phillips, P.T.
• Kimberly Ann Phillips, MA

• Mental Health Counselor in Schaumburg, IL
• Providers in Schaumburg, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; 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.