Provider Demographics
NPI:1679812937
Name:PETERSON PSYCHOLOGICAL SERVICES, INC
Entity type:Organization
Organization Name:PETERSON PSYCHOLOGICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:F
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:406-232-1595
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-0176
Mailing Address - Country:US
Mailing Address - Phone:406-232-1595
Mailing Address - Fax:406-232-1595
Practice Address - Street 1:18 N. 8TH ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301
Practice Address - Country:US
Practice Address - Phone:406-232-1595
Practice Address - Fax:406-232-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT119103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty