Individual
MATTHEW PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRPS
Contact information
Practice address
18033 PROMENADE PARK LN APT 112, LUTZ, FL 33548-7980
(770) 598-1852
Mailing address
11469 OLIVE BLVD # 264, SAINT LOUIS, MO 63141-7108
(314) 200-5851
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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