1831512524 NPI number — MRS. SUSAN DENISE PETERSON LMFT, LMHC,NCC,CSAC

Table of content: MRS. SUSAN DENISE PETERSON LMFT, LMHC,NCC,CSAC (NPI 1831512524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831512524 NPI number — MRS. SUSAN DENISE PETERSON LMFT, LMHC,NCC,CSAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERSON
Provider First Name:
SUSAN
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT, LMHC,NCC,CSAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEYER, BROTHERTON, FOSHEE
Provider Other First Name:
SUSAN
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831512524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98338-0094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-636-1649
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9040 JACKSON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-967-2712
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2014

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: 101YA0400X , with the licence number:  1674-12 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MHC 309 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFT 369 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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