Active NPI
Patti K Peterson, LPC
- Professional Counselor
- Lees Summit, MO
National Provider Identifier
1720185416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 002238
- Practice address
- 3610 NW Blue Jacket Dr
Lees Summit, MO 64064-3012 - Phone
- (816) 510-1172
- Fax
- (816) 373-1128
- NPI assigned
- Sep 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 002238 | MO | Primary |
| Professional Counselor | 101YP2500X | 157 | KS |
Addresses
Primary practice location
3610 NW Blue Jacket Dr
Lees Summit, MO 64064-3012
Mailing address
3610 NW Blue Jacket Dr
Lees Summit, MO 64064-3012
Phone (816) 510-1172
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 157 | KS | MD | Addiction (Substance Use Disorder) Counselor |
| 002238 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366416000000",
"number": "1720185416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3610 NW BLUE JACKET DR",
"city": "LEES SUMMIT",
"state": "MO",
"postal_code": "640643012",
"telephone_number": "816-510-1172",
"fax_number": "816-373-1128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3610 NW BLUE JACKET DR",
"city": "LEES SUMMIT",
"state": "MO",
"postal_code": "640643012",
"telephone_number": "816-510-1172",
"fax_number": "816-373-1128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "PATTI",
"middle_name": "K",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-17",
"last_updated": "2013-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "002238",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "KS",
"license": "157",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lees Summit, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.