Individual
BETH M PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY. D. HSPP
Contact information
Practice address
421 CHESTNUT ST, EVANSVILLE, IN 47713-1227
(812) 426-9779
(812) 426-6610
Mailing address
PO BOX 3868, EVANSVILLE, IN 47737-3868
(812) 426-9779
(812) 426-6610
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042022A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200806070
—
IN
01
—
371620
MHN TRICARE
IN
Enumeration date
12/05/2005
Last updated
01/09/2013
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