Provider Demographics
NPI:1174952725
Name:PETERSON, CODY CRAIG (BA)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:CRAIG
Last Name:PETERSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W BERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-1101
Mailing Address - Country:US
Mailing Address - Phone:303-798-0128
Mailing Address - Fax:303-798-9640
Practice Address - Street 1:2200 W BERRY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1101
Practice Address - Country:US
Practice Address - Phone:303-798-0128
Practice Address - Fax:303-798-9640
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health