Individual
MR. JAMES S PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD ABPN
Contact information
Practice address
1400 W MAIN, SUITE 16, CARBONDALE, IL 62901
(618) 529-2227
(618) 529-2227
Mailing address
PO BOX 583, CARBONDALE, IL 62903
(618) 529-2227
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Enumeration date
03/27/2007
Last updated
07/08/2007
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