Individual
JOHNATHON DAHLIN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCMHC, LPC
Contact information
Practice address
1268 W SOUTH JORDAN PKWY STE 300, SOUTH JORDAN, UT 84095-4653
(801) 515-5850
(801) 254-9755
Mailing address
PO BOX 95868, SOUTH JORDAN, UT 84095-0868
(801) 515-5850
(801) 254-9755
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
11125479-6004
UT
101YP2500X
Professional Counselor
95059
TX
Other
Enumeration date
08/04/2022
Last updated
09/25/2024
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