Individual
MS. JUDETH PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., LPC
Contact information
Practice address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(307) 688-5000
(307) 688-5015
Mailing address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(307) 688-5000
(307) 688-5015
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-1129
WY
101YA0400X
Addiction (Substance Use Disorder) Counselor
1512
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC-1129
STATE OF WYOMING MENTAL HEALTH PROFESSIONS LICENSING BOARD
WY
Enumeration date
01/22/2007
Last updated
08/25/2011
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