Active NPI
Jeffery J Peterson, PH.D.
- Counseling Psychologist
- Tampa, FL
National Provider Identifier
1962491621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 1307
- Practice address
- 11707 Club Dr
Tampa MHBS Clinic / Opc
Tampa, FL 33612-5521 - Phone
- (813) 631-7121
- NPI assigned
- Oct 17, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 1307 | AL | Primary |
Addresses
Primary practice location
11707 Club Dr
Tampa MHBS Clinic / Opc
Tampa, FL 33612-5521
Mailing address
11707 Club Dr
Tampa MHBS Clinic / Opc
Tampa, FL 33612-5521
Phone (813) 631-7121
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1307 | AL | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188432000000",
"number": "1962491621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11707 CLUB DR",
"address_2": "TAMPA MHBS CLINIC / OPC",
"city": "TAMPA",
"state": "FL",
"postal_code": "336125521",
"telephone_number": "813-631-7121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11707 CLUB DR",
"address_2": "TAMPA MHBS CLINIC / OPC",
"city": "TAMPA",
"state": "FL",
"postal_code": "336125521",
"telephone_number": "813-631-7121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JEFFERY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-17",
"last_updated": "2007-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "AL",
"license": "1307",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.