Individual provider · NPI-1

Kristina Petersen

Social Worker, Clinical · Bullhead City, AZ

NPI number1104229806
StatusActive
Last updated in NPPESOct 8, 2014

Details

NPI
1104229806
Entity type
Individual (NPI-1)
Name
Kristina Petersen
Sex
Female
Sole proprietor
No
Enumeration date
Oct 8, 2014
Last updated
Oct 8, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1041C0700X Social Worker, Clinical13439AZYes

Practice location

2580 Hway 95 # 1250
Bullhead City, AZ 86442-7491

Phone 928-763-7776 · Fax 928-763-7786

Mailing address

3450 N 3rd St
Phoenix, AZ 85012-2331

Phone 602-257-9339 · Fax 602-265-8533

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