Individual
PETER C PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
414 N 7TH ST, BISMARCK, ND 58501-4423
(701) 323-6543
(701) 323-5709
Mailing address
PO BOX 5501, BISMARCK, ND 58506-5501
(701) 323-6000
(701) 323-5709
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
119
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16931
—
ND
Enumeration date
08/31/2006
Last updated
09/11/2007
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