Jeremy Hayden Petersen

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MHCA.MC.70074370 Issued in WA

Practice address

16000 Bothell Everett Hwy Ste 360
Mill Creek, WA 98012-1577

Phone

(425) 357-9111

NPI assigned

Mar 3, 2026

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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.

• Mill Creek Family Services, PLLC

  • Mental Health Counselor
  • Mill Creek, WA
  • NPI 1902241623
  NPD (past)

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

{
    "created_epoch": "1772496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773014400000",
    "number": "1730034877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16000 BOTHELL EVERETT HWY STE 360",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121577",
            "telephone_number": "928-310-6580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16000 BOTHELL EVERETT HWY STE 360",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121577",
            "telephone_number": "425-357-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JEREMY",
        "middle_name": "HAYDEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-03-03",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MHCA.MC.70074370",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CDPT.CO.70092032",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Mill Creek, WA
• Providers in Mill Creek, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; 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.