Individual
BENJAMIN BRADLEY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3521 STANFORD RD APT 308-0312, FORT COLLINS, CO 80525-4079
(612) 408-9870
Mailing address
3521 STANFORD RD APT 308-0312, FORT COLLINS, CO 80525-4079
(612) 408-9870
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
171W00000X
Contractor
—
—
Other
Enumeration date
05/08/2024
Last updated
05/08/2024
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