Individual
ADAM PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC III, CSWA
Contact information
Practice address
200 BEATTY ST, MEDFORD, OR 97501-5811
(541) 476-2373
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19-10-15
OR
101YM0800X
Mental Health Counselor
A5586
OR
Other
Enumeration date
05/27/2020
Last updated
05/27/2020
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