Provider Demographics
NPI:1396171625
Name:PETERSON, SHARYL BENDER (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARYL
Middle Name:BENDER
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHARYL
Other - Middle Name:ANN
Other - Last Name:BENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:951 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3538
Mailing Address - Country:US
Mailing Address - Phone:970-589-4973
Mailing Address - Fax:970-248-9006
Practice Address - Street 1:951 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3538
Practice Address - Country:US
Practice Address - Phone:970-589-4973
Practice Address - Fax:970-248-9006
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0006373101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor