Provider Demographics
NPI:1316754955
Name:PETERSON, TINA LEANNE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LEANNE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:GEELHOED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 ARAPAHOE AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5862
Mailing Address - Country:US
Mailing Address - Phone:616-540-3990
Mailing Address - Fax:
Practice Address - Street 1:100 ARAPAHOE AVE STE 14
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5862
Practice Address - Country:US
Practice Address - Phone:616-540-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0022838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional