Provider Information for 1548629033
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TANISHA PETERSON LCSW
Sex: Female
NPI: 1548629033
Last Updated: 2019-06-25
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1548629033 | ||||||||
| Enumeration Date | 2016-02-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2350 PARK PLACE DR APT 51 GRETNA, LA 70056-3074 United States Phone: 504-430-6903 | Fax: | ||||||||
| Primary Practice Address | 1799 STUMPF BLVD STE 10 TERRYTOWN, LA 70056-3950 United States Phone: 504-430-6903 | Fax: | ||||||||
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