Individual
MR. JOHN PETERSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
610 MAIN ST, LAFAYETTE, IN 47901-1451
(765) 423-2638
(765) 742-4196
Mailing address
610 MAIN ST, LAFAYETTE, IN 47901-1451
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
IN
Other
Enumeration date
02/05/2018
Last updated
02/05/2018
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