John Richard Pederson, MS COUNSELING

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LH00003463 Issued in WA

Practice address

15609 SE Mill Plain Blvd
Suite Number 600
Vancouver, WA 98684-8905

Phone

(360) 254-3855

NPI assigned

Jan 22, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261180800000",
    "number": "1992859540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17808 SE 14TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986837221",
            "telephone_number": "360-254-3855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15609 SE MILL PLAIN BLVD",
            "address_2": "SUITE NUMBER 600",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986848905",
            "telephone_number": "360-254-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "JOHN",
        "middle_name": "RICHARD",
        "credential": "MS COUNSELING",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2009-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH00003463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Rose Peck
• Jeremiah Peck
• Nicholas M. Peck, D.C.
• William Peck, AAC, CPC
• Charlene Pederson, CG
• Kim R Pederson, MHS PA-C
• Shannon Gerald Pederson, RPH
• Pediatric Services of America, LLC
• Pediatric Services of America, LLC
• Pediatric Services of America, LLC

• Mental Health Counselor in Vancouver, WA
• Providers in Vancouver, 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 Dec 19, 2009; 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.