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Individual
MRS. JANICE LOUISE PETERSON
Active
Individual
MRS. JANICE LOUISE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
17543
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007793396
AETNA ID
TX
01
—
10016277
AMERIGROUP ID
TX
05
—
148937901
—
TX
01
—
347889000
MAGELLAN HLTH ID
TX
01
—
478064
VALUE OPTIONS PROVIDER ID
TX
01
—
6098LC
BCBS ID
TX
Enumeration date
01/29/2007
Last updated
07/09/2007
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