Provider Demographics
NPI:1063867703
Name:PETERSON, FAREN JANE (LPC)
Entity type:Individual
Prefix:
First Name:FAREN
Middle Name:JANE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 VERMONT DR
Mailing Address - Street 2:APT E201
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6173
Mailing Address - Country:US
Mailing Address - Phone:190-628-1386
Mailing Address - Fax:
Practice Address - Street 1:1006 ROBERTSON ST
Practice Address - Street 2:BLDG 2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3900
Practice Address - Country:US
Practice Address - Phone:197-077-5706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012989101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional