Kyle Peterson, LCMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11390362-6004 Issued in UT

Practice address

415 N Main St Ste 101
Cedar City, UT 84721-6158

Phone

(701) 852-3328

Fax

(651) 925-0057

NPI assigned

Oct 12, 2018

Last updated

Mar 31, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Village Family Service Center

  dba The Village Family Service Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fargo, ND
  • NPI 1568492353
  NPD (past)
• Village Family Service Center

  dba The Village Family Service Center

  • Substance Abuse Rehabilitation Facility
  • Fargo, ND
  • NPI 1952679318
  NPD (past)

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

{
    "created_epoch": "1539302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680220800000",
    "number": "1972078251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 N MAIN ST STE 101",
            "city": "CEDAR CITY",
            "state": "UT",
            "postal_code": "847216158",
            "telephone_number": "435-250-4367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 N MAIN ST STE 101",
            "city": "CEDAR CITY",
            "state": "UT",
            "postal_code": "847216158",
            "telephone_number": "701-852-3328",
            "fax_number": "651-925-0057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KYLE",
        "credential": "LCMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-12",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "11390362-6004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryce Daniel Perkins, DO
• Sarah Persha, MA, CMHC
• Richard Dwain Persons, PA-C MPAS
• James Tyler Petersen, D.C.
• Alex Peterson
• Terasa Lynn Peterson
• Trevor Justin Peterson, NP-C
• Kelcie Petty
• Riley F Phelps, DPT
• Braxton Pickett

• Mental Health Counselor in Cedar City, UT
• Providers in Cedar City, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.