Petersen Enterprises Inc

Primary specialty

CounselorTaxonomy code 101Y00000X

License

2179 Issued in CO

Legal business name

PETERSEN ENTERPRISES INC

Doing business as

Innovative Neurofeedback Therapy

Practice address

4529 Stover St
Fort Collins, CO 80525-3261

Phone

(970) 234-1147

NPI assigned

Jan 15, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jennifer Petersen, MA, LPCNPI 1013311398

Title

President

Phone

(970) 234-1147

Specialties & licenses 1

Addresses

Other names 1

• Innovative Neurofeedback Therapy Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Petersen, M.A.

  • Counselor
  • Fort Collins, CO
  • NPI 1013311398
  NPD (past) Authorized official

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

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421280000000",
    "number": "1518356484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4213 DURANGO PL",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805264103",
            "telephone_number": "970-234-1147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4529 STOVER ST",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253261",
            "telephone_number": "970-234-1147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-15",
        "last_updated": "2015-01-15",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-234-1147",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": "CO",
            "license": "2179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative Neurofeedback Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Pestle
• Glen Petcavage, D.C.
• Cassandra A Peter, RN
• Christy Peters
• Katherine Peters, LCSW
• James Lee Petersen, PA-C
• Jennifer Petersen, M.A.
• Lyle Petersen, M.D.
• Tegan Cleo Petersen
• Aden Peterson, DDS

• Counselor in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; 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.