Individual provider · Type 1 NPI

Russell Henry Peterson, M.S.

Mental Health Counselor · Idaho Falls, ID

NPI number 1093879637 Active

Practice location

2375 E Sunnyside Rd, Suite C
Idaho Falls, ID 83404-8280

Call (208) 529-5777 Map

Fax (208) 529-5778

Mailing address

4360 E 278 N
Rigby, ID 83442-5892

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XLCPC-3125 (ID)

Mental Health Counselor: Definition to come...

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About NPI 1093879637

Russell Henry Peterson, M.S.'s National Provider Identifier is 1093879637, issued on Dec 20, 2006. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Idaho Falls, ID. The record was last updated on Jul 8, 2007.