Petersen, Ann Renee
Petersen, Ann Renee is an sole proprietor health care provider with primary practice located at 4686 Corrales Rd , Corrales NM 87048-8610. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Petersen, Ann Renee can be contacted via phone (505) 400-9913.Contact Information
Primary practice address
4686 Corrales Rd
Corrales NM 87048-8610
Phone: (505) 400-9913
Fax: (505) 890-1527
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 0069062 | New Mexico |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 0098101 | New Mexico |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 0119911 | New Mexico |
Profile Details
| NPI number | 1629170790 |
|---|---|
| LBN Legal business name | Petersen, Ann Renee |
| Credentials | L.P.C.C., N.C.C. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 1st, 2006 |
| Last updated | May 24th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629170790 | NPPES |
| New Mexico | MEDICAID | 33007829 | |
| New Mexico | Other | 615695 | |
| New Mexico | Other | 613923500 | |
| New Mexico | Other | 201-047-937 | |
| New Mexico | Other | 0000036606 | |
| New Mexico | Other | 10012607 |
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