Individual
BETTY ILENE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
627 NE EVANS ST, MCMINNVILLE, OR 97128-3923
(971) 261-2254
Mailing address
627 NE EVANS ST, MCMINNVILLE, OR 97128-3923
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-22-1686
OR
175T00000X
Peer Specialist
—
—
Other
Enumeration date
08/26/2019
Last updated
03/21/2023
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