Individual
SHANE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5600 W 95TH ST STE 216, OVERLAND PARK, KS 66207-2968
(913) 602-4039
Mailing address
5600 W 95TH ST STE 216, OVERLAND PARK, KS 66207-2968
(913) 602-4039
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
3123
KS
Other
Enumeration date
01/14/2020
Last updated
01/14/2020
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