Individual
MARRISSA MARIE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12110 PORT GRACE BLVD STE 101, LA VISTA, NE 68128-3190
(402) 325-1290
Mailing address
12110 PORT GRACE BLVD STE 101, LA VISTA, NE 68128-3190
(402) 325-1290
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
P-2244
NE
Other
Enumeration date
12/02/2024
Last updated
05/22/2025
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