Provider Demographics
NPI:1114357134
Name:PETTERSEN, RACHEL (LPC-MH, QMHP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:PETTERSEN
Suffix:
Gender:F
Credentials:LPC-MH, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N 7TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2710
Mailing Address - Country:US
Mailing Address - Phone:605-641-2661
Mailing Address - Fax:605-644-5121
Practice Address - Street 1:115 N 7TH ST STE 4
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2710
Practice Address - Country:US
Practice Address - Phone:605-641-2661
Practice Address - Fax:605-644-5121
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH20297101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health