Individual
PAUL WYNN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAMFT
Contact information
Practice address
17 FOLKINGHAM LN, BELLA VISTA, AR 72715-3042
(501) 260-7324
Mailing address
PO BOX 5922, BELLA VISTA, AR 72714-0922
(501) 260-7324
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
F1811011
AR
Other
Enumeration date
02/16/2019
Last updated
02/16/2019
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