Jon W Peterson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 6987 Issued in CA

Practice address

25401 Cabot Rd
Suite 213
Laguna Hills, CA 92653-5524

Phone

(949) 363-7386

Fax

(949) 363-8974

NPI assigned

Jun 22, 2006

Sex

Male

Sole proprietor

No

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 CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Jon Peterson Psychologist PHD PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Laguna Hills, CA
  • NPI 1396983128
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972549236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25401 CABOT RD",
            "address_2": "SUITE 213",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926535524",
            "telephone_number": "949-363-7386",
            "fax_number": "949-363-8974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25401 CABOT RD",
            "address_2": "SUITE 213",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926535524",
            "telephone_number": "949-363-7386",
            "fax_number": "949-363-8974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JON",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 6987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Pestotnik, DPT
• Peter N Abas, DDS, Inc
• Kylie Peterman
• Amy Christine Marquardt Peters, D.O.
• Craig M Petersen, D.C.
• Nicole Peterson, OTR
• Stephanie Pfannenstiel, N.P.
• Pfautz Chiropractic Corporation, a Professional Corporation
• L Michael Pfautz, D.C.
• Sarah Jauregui Pfeifer, RN, IBCLC

• Clinical Psychologist in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.