Provider Demographics
NPI:1750622965
Name:PETERSON, BETH SUE (LLPC)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:SUE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 113
Mailing Address - Street 2:18 W. MAIN ST. SUITE B
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160
Mailing Address - Country:US
Mailing Address - Phone:734-439-3100
Mailing Address - Fax:
Practice Address - Street 1:18 W. MAIN ST. SUITE B
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160
Practice Address - Country:US
Practice Address - Phone:734-439-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional