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Individual
JON WALTER PETERSEN
Active
Individual
JON WALTER PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, M.ED, LPCC, CMHC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
12348521-6004
UT
101YP2500X
Professional Counselor
Primary
2463
MN
Other
Enumeration date
11/21/2019
Last updated
06/13/2025
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