Provider Demographics
NPI:1194095968
Name:PETERSON, AMIE (LPC, LPCC, LMHC)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC, LPCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 SHASTA DR
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1537
Mailing Address - Country:US
Mailing Address - Phone:509-713-2150
Mailing Address - Fax:
Practice Address - Street 1:907 SHASTA DR
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1537
Practice Address - Country:US
Practice Address - Phone:509-713-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1667101YA0400X
MNCC01565101YM0800X
ND847-8-1-15-304101YM0800X
WA61348595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)