Individual
RANDOLPH SCOTT PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3400 LEBANON RD, VA TVHS - PSYCHOLOGY SERVICES (116B), MURFREESBORO, TN 37129-1392
(615) 225-3933
(615) 225-6361
Mailing address
3400 LEBANON RD, VA TVHS - PSYCHOLOGY SERVICES (116B), MURFREESBORO, TN 37129-1392
(615) 225-3933
(615) 225-6361
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
880
SC
103T00000X
Psychologist
880
SC
103TB0200X
Cognitive & Behavioral Psychologist
880
SC
103TC0700X
Clinical Psychologist
880
SC
103TH0100X
Health Service Psychologist
880
SC
103TP2701X
Group Psychotherapy Psychologist
880
SC
103TR0400X
Rehabilitation Psychologist
880
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PS0384
—
SC
Enumeration date
01/18/2007
Last updated
04/29/2016
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