Amy Peterson, LPC-IT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4510226 Issued in WI

Practice address

6233 Durand Ave Ste F
Mount Pleasant, WI 53406-4961

Phone

(262) 554-8165

NPI assigned

Dec 8, 2019

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Tungseth Psychotherapy Clinic LLC

  • Professional Counselor
  • Racine, WI
  • NPI 1609927011
  NPD (past)

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

{
    "created_epoch": "1575763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575763200000",
    "number": "1679110779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6905 BOBOLINK RD",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534021344",
            "telephone_number": "262-221-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6233 DURAND AVE STE F",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064961",
            "telephone_number": "262-554-8165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6233 Durand Ave Ste F",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "WI",
            "postal_code": "534064961",
            "country_code": "US",
            "telephone_number": "262-554-8165",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "AMY",
        "credential": "LPC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-08",
        "last_updated": "2019-12-08",
        "certification_date": "2019-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "4510226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2019; 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.