MELISSA EDWARDS PETERSEN (NPI# 1144860917) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144860917 |
| Entity Type | Individual |
| Full Name | MELISSA EDWARDS PETERSEN |
| Credential | PHD |
| Practice Address |
855 Montgomery St Fort Worth TX 76107-2553 |
| Practice Telephone | 8177352200 |
| Mailing Telephone | 8177352200 |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2020-10-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 36939 | TX | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
36939 | TX | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245783893 | Melissa J Petersen | Marriage & Family Therapist | 543 Plumas St, Reno, NV 89509 | 2016-08-01 |
| 1235513128 | Melissa Petersen | Physician Assistant | 4300 Alton Rd Ste 2110, Miami Beach, FL 33140-2948 | 2015-07-10 |
| 1306195045 | Melissa Anne Petersen | Speech-Language Pathologist | 20420 68th Ave W, Lynnwood, WA 98036-7405 | 2012-09-07 |
| 1952542870 | Melissa Petersen | Dentist | 2950 Eureka Way, Redding, CA 96001-0200 | 2009-03-24 |
| 1215106042 | Melissa T Petersen | Nurse Practitioner | 315 Winn Way, Decatur, GA 30030-2111 | 2008-02-26 |
| 1255537585 | Melissa Ann Petersen | Massage Therapist | 3217 Meridian Ave E, Edgewood, WA 98371 | 2007-06-24 |
| Street Address |
855 MONTGOMERY ST |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76107-2553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831194455 | Patricia Lowrimore | Psychiatry & Neurology | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2005-06-20 |
| 1194353417 | Jason L Thompson | Student in an Organized Health Care Education/Training Program | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2020-03-31 |
| 1639701808 | Tyrane Roberts-lagrone | Pharmacist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2020-02-06 |
| 1629553813 | Lisa Jane Killam-worrall | Pharmacist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2018-10-03 |
| 1598250607 | Sima Taj Mozdbar | Optometrist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2018-06-30 |
| 1588153993 | Kristen Reuter | Social Worker | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2018-05-02 |
| 1114431624 | Emily J. Clark | Counselor | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2017-11-20 |
| 1275073215 | Elizabeth Svyatoslavna Balyakina | Student in an Organized Health Care Education/Training Program | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2017-02-23 |
| 1588103659 | Frederick Olen Barnum Iv | Family Medicine | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2017-02-21 |
| 1760926695 | Jane Elizabeth Classen | Nurse Practitioner | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2016-12-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683602 | Renovo Wound and Hyperbarics Pllc | Emergency Medicine | 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 | 2020-09-15 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1093351355 | Raymond Iannone | Pharmacist | 850 Montgomery St, Suite #310, Fort Worth, TX 76107 | 2019-11-21 |
| 1053963744 | Cumulus Injury Resolution, Inc. | Chiropractor | 4936 Byers Avenue, Fort Worth, TX 76107 | 2019-07-12 |
| 1770135576 | Shadia Osakwe | Physician Assistant | 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 | 2019-07-11 |
| 1568945442 | Sachin P Patel | Physical Therapist | 4825 Wellesley St, Fort Worth, TX 76107 | 2018-09-07 |
| 1023594025 | Ftw Pharmacy Services Inc | Durable Medical Equipment & Medical Supplies | 2912 W 6th St Ste 150, Fort Worth, TX 76107 | 2018-07-13 |
| 1669974325 | Helen Williamson Elliott | Counselor | 1751 River Run #217, Fort Worth, TX 76107 | 2018-03-08 |
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| Find all providers in zip 76107 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700101433 | Michael Glenn Hightower | Clinical Neuropsychologist | 6 Lucas Ln, Fort Worth, TX 76134-3407 | 2010-04-06 |
| 1891996963 | Christopher Anagnostis | Clinical Neuropsychologist | 6410 Southwest Blvd, Suite 105, Fort Worth, TX 76109 | 2007-05-29 |
| 1386713691 | Burton J Zung | Clinical Neuropsychologist | 5658 Wescreek Dr Ste 400, Ste 400, Fort Worth, TX 76133 | 2006-11-08 |
| 1962589507 | Marsha T Gabriel | Clinical Neuropsychologist | 429 S Ballinger St, Fort Worth, TX 76104-1008 | 2006-11-01 |
| 1164507273 | Beth Colaluca | Clinical Neuropsychologist | 1516 Cooper St, Fort Worth, TX 76104-2710 | 2006-10-26 |
| 1053300350 | Robert P Odgers | Clinical Neuropsychologist | 1814 8th Ave, B, Fort Worth, TX 76110-1354 | 2005-10-19 |
| 1508863036 | Clifford Alan Hopewell | Clinical Neuropsychologist | 1015 Pennsylvania Ave, Ste 2, Fort Worth, TX 76104-2259 | 2005-06-30 |
| 1699073114 | Robert Scott Hilborn | Clinical Neuropsychologist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2011-03-08 |
| 1427084193 | Sidney E O'bryant | Clinical Neuropsychologist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2006-06-24 |
| 1922060078 | Alan Belmore Frol | Clinical Neuropsychologist | 855 Montgomery St, Fort Worth, TX 76107-2553 | 2006-04-04 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76107 |
Please comment or provide details below to improve the information on MELISSA EDWARDS PETERSEN.
| 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.