| NPI | 1336663145 |
|---|---|
| Former Name | PAYTON PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 1252-124) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 585-228) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2023-02-03 |