Provider Demographics
NPI:1366151524
Name:PETERSEN, JAMIE CHRISTINE (LMFTA)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:CHRISTINE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 S 101ST ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-1543
Mailing Address - Country:US
Mailing Address - Phone:720-839-1198
Mailing Address - Fax:
Practice Address - Street 1:1236 S 101ST ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-1543
Practice Address - Country:US
Practice Address - Phone:720-839-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMFTA.MG.61371636106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist