| NPI | 1447457494 |
|---|---|
| Former Name | STEPHANIE ELAINE PETERSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 32918) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 1345) |
| 103T00000X Psychologist (Licence: TX 32918) | |
| 103TC1900X Psychologist, Counseling (Licence: KS 1345) | |
| 103TC1900X Psychologist, Counseling (Licence: TX 32918) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2022-05-09 |