Petersen, Beth M

Petersen, Beth M is an individual health care provider with primary practice located at 421 Chestnut St , Evansville IN 47713-1227. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Petersen, Beth M can be contacted via phone (812) 426-9779.

Contact Information

Primary practice address
421 Chestnut St Evansville IN 47713-1227
Phone: (812) 426-9779
Fax: (812) 426-6610
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 20042022A Indiana

Profile Details

NPI number 1518941384
LBN Legal business name Petersen, Beth M
Credentials PSY. D. HSPP
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 5th, 2005
Last updated Jan 9th, 2013 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518941384 NPPES
Indiana MEDICAID 200806070
Indiana Other 371620

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