Connie Lynn Petersen, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

724 Issued in NE

Practice address

333 W Norfolk Ave Ste 201
Norfolk, NE 68701-5221

Phone

(402) 379-2030

Fax

(402) 379-3933

NPI assigned

Aug 21, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Oasis Counseling InternationalGroup PAC ID 1456367168, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Oasis Counseling International

  • Mental Health Counselor
  • Norfolk, NE
  • NPI 1588629612
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1598958811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 W NORFOLK AVE STE 201",
            "city": "NORFOLK",
            "state": "NE",
            "postal_code": "687015221",
            "telephone_number": "402-379-2030",
            "fax_number": "402-379-3933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 W NORFOLK AVE STE 201",
            "city": "NORFOLK",
            "state": "NE",
            "postal_code": "687015221",
            "telephone_number": "402-379-2030",
            "fax_number": "402-379-3933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "CONNIE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-21",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NE",
            "license": "310",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NE",
            "license": "724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10027025403",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alize Perry
• Deontae Perry
• Susan Perry
• Sherri Peter
• Angela Petersen
• Jamie Petersen
• Kyla Petersen
• Kelsey Peterson
• Lorissa Peterson
• Natasha Peterson

• Clinical Psychologist in Norfolk, NE
• Providers in Norfolk, NE by specialty
• Clinical Psychologist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.