Krista S Petersen

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

5691 S Redwood Rd
#16
Taylorsville, UT 84123-5420

Phone

(801) 265-3895

Fax

(801) 236-1235

NPI assigned

May 15, 2014

Sex

Female

Sole proprietor

Yes

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

Enrolled in UT

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Ted a. Harris, PHD, Licensed Psychologist, Inc.

  • Clinical Psychologist
  • Taylorsville, UT
  • NPI 1487768826
  Medicare reassignment NPD

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

{
    "created_epoch": "1400112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400112000000",
    "number": "1659782381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5691 S REDWOOD RD",
            "address_2": "#16",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841235420",
            "telephone_number": "801-265-3895",
            "fax_number": "801-236-1235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5691 S REDWOOD RD",
            "address_2": "#16",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841235420",
            "telephone_number": "801-265-3895",
            "fax_number": "801-236-1235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KRISTA",
        "middle_name": "S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-15",
        "last_updated": "2014-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Perko
• Amanda Perry
• Kathryn Perry
• Alexis Gundersen Petersen, FNP
• Cassi Petersen
• Robert James Petersen
• Tara Petersen, SSW
• Teniah Petersen
• Austin Peterson
• Bethanie Gardiner Peterson, PHARM D

• Mental Health Counselor in Taylorsville, UT
• Providers in Taylorsville, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2014; 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.