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Individual
MR. TIMOTHY JAMES PETERSON
Active
Individual
MR. TIMOTHY JAMES PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LMHCA
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MC60568524
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MC 60568524
STATE LICENSE
WA
Enumeration date
07/15/2015
Last updated
04/20/2021
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