Provider Demographics
NPI:1386069565
Name:PETERSON, JEFF (LPC, LCPC)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SIOUX POINT RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5492
Mailing Address - Country:US
Mailing Address - Phone:605-215-6695
Mailing Address - Fax:
Practice Address - Street 1:211 SIOUX POINT RD STE 300
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5492
Practice Address - Country:US
Practice Address - Phone:605-215-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101101101YM0800X
NE2448101YM0800X
SD30907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health