MR. MATTHEW JOEL PETERSEN (NPI# 1154554004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154554004 |
| Entity Type | Individual |
| Full Name | MR. MATTHEW JOEL PETERSEN |
| Credential | LPC, LADC |
| Practice Address |
711 Stanton L Young Blvd Oklahoma City OK 73104-5023 |
| Mailing Address |
3632 Nw 65th St Oklahoma City OK 73116-2006 |
| Practice Telephone | 4052718001 |
| Practice Fax Number | 4052716264 |
| Mailing Telephone | 4053650556 |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2013-04-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
1035 | OK | Behavioral Health & Social Service Providers |
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
4741 | OK | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200379360A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477607083 | Matthew D. Petersen | Specialist/Technologist, Other | 11704 W Center Rd Ste 200, Omaha, NE 68144-4327 | 2007-01-22 |
| 1710062351 | Matthew Petersen | Urology | 24 Research Way, Suite 500, East Setauket, NY 11733 | 2006-10-25 |
| 1396206397 | Matthew Petersen | Student in an Organized Health Care Education/Training Program | 1600 Sw Archer Rd Ste 4102, Gainesville, FL 32610-3003 | 2019-03-31 |
| 1629565767 | Matthew Gary Petersen | Student in an Organized Health Care Education/Training Program | 2150 Pennsylvania Ave Nw, Washington, DC 20037-3201 | 2018-04-14 |
| 1053764639 | Matthew Petersen | Physician Assistant | 11800 Fm 1960 Rd W, Houston, TX 77065-3840 | 2016-07-19 |
| 1972767556 | Matthew James Petersen | Radiology | 1701 N Senate Blvd, Radiology Dept, Indianapolis, IN 46202-1239 | 2008-07-14 |
| 1558569038 | Matthew L Petersen | Family Medicine | 4600 Valley Road, Suite 200, Lincoln, NE 68510-4844 | 2007-07-06 |
| Street Address |
711 STANTON L YOUNG BLVD |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73104-5023 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588640965 | Karen K Kinney | Internal Medicine | 711 Stanton L Young Blvd, Ppb Suite 430, Oklahoma City, OK 73104-5023 | 2005-12-19 |
| 1487283693 | Alexander Thomas Sanders | Orthopaedic Surgery | 711 Stanton L Young Blvd, Oklahoma City, OK 73104-5023 | 2020-04-08 |
| 1073142204 | Raja Umair Ullah | Orthopaedic Surgery | 711 Stanton L Young Blvd, Oklahoma City, OK 73104-5023 | 2020-04-08 |
| 1811526106 | John Abraham Geha | Orthopaedic Surgery | 711 Stanton L Young Blvd, Oklahoma City, OK 73104-5023 | 2020-04-07 |
| 1417586710 | Conner Alexander Patrick | Orthopaedic Surgery | 711 Stanton L Young Blvd, Oklahoma City, OK 73104-5023 | 2020-04-07 |
| 1558857078 | Ferdinande Djioto | Nurse Practitioner | 711 Stanton L Young Blvd, Oklahoma City, OK 73104-5023 | 2018-07-09 |
| 1699265801 | Abby Rose Rubenstein | Student in an Organized Health Care Education/Training Program | 711 Stanton L Young Blvd, Oklahoma City, OK 73104-5023 | 2018-05-14 |
| 1083147821 | Jonathan Duane Ringenberg | Orthopaedic Surgery | 711 Stanton L Young Blvd, Ppb-1100, Oklahoma City, OK 73104-5023 | 2017-04-08 |
| 1902339732 | Zackary Paul Burrow | Orthopaedic Surgery | 711 Stanton L Young Blvd, 1300, Oklahoma City, OK 73104-5023 | 2017-04-08 |
| 1255864096 | Travis George Veitenheimer | Orthopaedic Surgery | 711 Stanton L Young Blvd, Ppb-1100, Oklahoma City, OK 73104-5023 | 2017-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356979645 | Kayla Campbell | Dietitian, Registered | Stephenson Cancer Center, 800 Ne 10th Street, Oklahoma City, OK 73104 | 2020-03-31 |
| 1447715453 | Roman Michael Garcia | Dentist | Ou Children's Physicians - Dental Clinic, 1200 Children's Ave, 8f, Oklahoma City, OK 73104 | 2019-02-04 |
| 1265902340 | Jenna Lyn Celii | Registered Nurse | 920 Sl Young Blvd Ste 1140, Oklahoma City, OK 73104 | 2018-11-30 |
| 1407337462 | Opus Medical, LLC | Psychiatry & Neurology | 4 Ne 10th St Suite 467, Oklahoma City, OK 73104 | 2018-08-27 |
| 1316433295 | Syed Muhammad Shakaib Quadri | Pathology | 940 Stanton L. Young Blvd., Bmsb 451, Oklahoma City, OK 73104 | 2018-07-03 |
| 1447746417 | Nimrah Bader | Internal Medicine | 800 Stanton L. Young Blvd., Aat 6300, Oklahoma City, OK 73104 | 2018-07-02 |
| 1417440793 | Helen Judith Turkson Apetor | Nurse Practitioner | 700 Ne 13th, Oklahoma City, OK 73104 | 2018-06-11 |
| 1003307935 | Mary Katlin Nixon | Obstetrics & Gynecology | 800 Stanton L Young Blvd Ste 2319, Oklahoma City, OK 73104 | 2018-05-26 |
| 1558851220 | Bryce Yohannan | Student in an Organized Health Care Education/Training Program | 800 Stanton L Young Blvd, Aat 6300, Oklahoma City, OK 73104 | 2018-05-17 |
| 1346746690 | Kacy Anne Richburg | Orthopaedic Surgery | 711 Stanton L Young Blvd Ste 111, Oklahoma City, OK 73104 | 2018-04-04 |
| Find all providers in zip 73104 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639777410 | Larissa Wilson | Counselor | 9112 Rolling Green Ave, Oklahoma City, OK 73132-2055 | 2020-10-13 |
| 1497368179 | The Possibilities Place LLC | Counselor | 6900 Basswood Canyon Rd, Oklahoma City, OK 73162-7207 | 2020-08-24 |
| 1306457569 | Compassionate Hand Counseling Services Inc | Counselor | 1414 Sw 89th St Ste B, Oklahoma City, OK 73159-6312 | 2020-08-12 |
| 1942819081 | Michael Sylvester Radonski | Counselor | 14700 Rambling Creek Cir, Oklahoma City, OK 73142-9719 | 2020-07-24 |
| 1548895931 | Court Assistance Programs Inc. | Counselor | 600 N Dewey Avenue Suite 100, Oklahoma City, OK 73102 | 2020-03-06 |
| 1730713884 | Hanna Pauline Nassar | Counselor | 405 Nw 33rd St, Oklahoma City, OK 73118-8644 | 2020-02-27 |
| 1699319475 | Stephanie Gaynell Potts | Counselor | 1724 Ne 54th St, Oklahoma City, OK 73111-6832 | 2019-11-04 |
| 1962062471 | Babatunde Olumuyiwa Sosanya | Counselor | 1900 N Macarthur Blvd Ste 125, Oklahoma City, OK 73127-2650 | 2019-06-17 |
| 1598321440 | Tiba Counseling Center, Inc. | Counselor | 4301 Nw 63rd St Ste 305, Oklahoma City, OK 73116-1504 | 2019-05-16 |
| 1588132542 | Allison Martha Gibson | Counselor | 2525 Nw Expressway Ste 220, Oklahoma City, OK 73112-7227 | 2018-11-08 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.