Individual
JAMIE MIRANDA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
406 AIRPORT DR, FARMINGTON, NM 87401-5518
(505) 325-5358
(505) 564-8368
Mailing address
807 W APACHE ST, FARMINGTON, NM 87401-5527
(505) 325-5358
(505) 327-1482
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/25/2012
Last updated
09/25/2012
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