Most Relevant Information
Provider Data
| NPI Number: | 1003577164 |
| Provider Name: | LISA S PETERSON PHD |
| Entity Type: | Individual |
| Taxonomy Code: | 103TS0200X |
| Specialty: | Psychologist |
| License Number: | 394165 |
Most Important Dates
| Enumeration Date: | 12/31/2021 |
| Last Updated: | 12/31/2021 |
Provider Practice Location
505 S MAIN ST STE 249
LAS CRUCES
NM
880011243
Practice Location Phone/Fax
| Phone: | 5155275884 |
| Fax: |
Provider Mailing Location
505 S MAIN ST STE 249
LAS CRUCES
NM
880011243
Provider Mailing Phone/Fax
| Phone: | 5155275884 |
| Fax: |