Individual
MS. MICHELE LYNN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
322 1/2 DESOTO AVE, BELEN, NM 87002-4538
(505) 235-5737
Mailing address
322 1/2 DESOTO AVE, BELEN, NM 87002-4538
(505) 235-5737
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
514714525
NMDL
NM
Enumeration date
05/16/2017
Last updated
07/21/2022
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