Individual
NATHAN MARK PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1459 N MAIN ST, BOUNTIFUL, UT 84010-6092
(801) 298-2000
Mailing address
1459 NORTH MAIN STREET, BOUNTIFUL, UT 84010
(801) 298-2000
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
7350613-3501
UT
1041C0700X
Clinical Social Worker
Primary
7350613-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260022408
RAILROAD MEDICARE
UT
05
—
876000308007
—
UT
Enumeration date
09/29/2011
Last updated
11/28/2016
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