Reketta Peterson

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

APC006265 Issued in GA

Practice address

3875 Geist Rd Ste E190
Fairbanks, AK 99709-3564

Phone

(844) 942-2434

NPI assigned

Mar 12, 2018

Sex

Female

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

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.

• Arise Counseling, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fairbanks, AK
  • NPI 1326637539
  NPD Authorized official

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

{
    "created_epoch": "1520812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1972006435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 PEGER RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095169",
            "telephone_number": "907-971-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3875 GEIST RD STE E190",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093564",
            "telephone_number": "844-942-2434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1423 Peger Rd",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997095169",
            "country_code": "US",
            "telephone_number": "907-371-1300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "REKETTA",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-12",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "APC006265",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AK",
            "license": "164379",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bernard Joseph Pete
• Donald Brent Petersen
• David James Peterson, O.D.
• Ella Peterson
• Rayna Skye Peterson
• Kernise Petit-Beau
• Yelena Petkova
• Thomas Petrie, LMT
• Erin Elizabeth Pettis
• Darae Pheysey

• Professional Counselor in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Professional Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.