1043528334 NPI number — KACEY M PETERSON MS, LMHC

Table of content: KACEY M PETERSON MS, LMHC (NPI 1043528334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043528334 NPI number — KACEY M PETERSON MS, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERSON
Provider First Name:
KACEY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043528334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 E GRANT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASEY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50048-1011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-247-8114
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 NE 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50250-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-247-8114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  001334 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)