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KIMBERLY PETERSON MA, MFTI
NPI 1225396583
Marriage & Family Therapist in Santa Rosa, CA

Active since April 24, 2012Opted out of Medicare · through Jan 1, 2028
1160 N DUTTON AVE, SUITE 105, SANTA ROSA, CA 95401(707) 545-2700 Get Directions Write a Review

NPPES record last updated: November 5, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kimberly Peterson Ma, Mfti NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIMBERLY PETERSON MA, MFTI (NPI 1225396583) is an individual marriage & family therapist in Santa Rosa, California, licensed in California (65068) and active in the NPI registry since April 2012. She has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1225396583
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NameKIMBERLY PETERSONCredential: MA, MFTI
Location Address1160 N DUTTON AVE, SUITE 105Santa Rosa, CA 95401-4600
Mailing Address1160 N Dutton Ave, Suit 105Santa Rosa, CA 95401-4600 · (707) 326-9277
Phone(707) 545-2700
Sole ProprietorNo
Enumeration DateApril 24, 2012
Last NPPES UpdateNovember 5, 2013
✔ NPI 1225396583 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · 65068
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
1160 N DUTTON AVE, Santa Rosa, CA 95401
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Kimberly Peterson Ma, Mfti has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2024
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. STEVAN KERAM M.D.
Psychiatry & Neurology (Psychiatry)
1160 N DUTTON AVE, SUITE 255
SANTA ROSA, CA 95401
Sonoma County (707) 526-8800
CRYSTAL CARPENTER
Technician, Health Information (Assistant Record Technician)
1160 N DUTTON AVE, SUITE 105
SANTA ROSA, CA 95401
Sonoma County (707) 545-2700
MR. EVAN BACHELDER LMT
Mechanotherapist
1160 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (707) 541-6258
ALEXANDRA DEXTER ND
Naturopath
1160 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (707) 888-4191
PHILIPPA LOCKWOOD
Technician, Health Information (Assistant Record Technician)
1160 N DUTTON AVE, SUITE 105
SANTA ROSA, CA 95401
Sonoma County (707) 545-2700
LESLIE BURKE
Behavior Technician
1160 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (855) 223-7123
MRS. DANA ELIZABETH FALLS M.A., MFT
Marriage & Family Therapist
1160 N DUTTON AVE, SUITE 250
SANTA ROSA, CA 95401
Sonoma County (707) 696-6138
ALANNA DAWKINS
Counselor
1160 N DUTTON AVE
SANTA ROSA, CA 95401
Sonoma County (707) 545-2700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberly Peterson's NPI number?

The NPI number for Kimberly Peterson is 1225396583. It was assigned to this individual provider in the NPPES registry on April 24, 2012.

Where is Kimberly Peterson located?

Kimberly Peterson practices at 1160 N Dutton Ave Suite 105, Santa Rosa, CA 95401. The listed phone number is (707) 545-2700.

What is Kimberly Peterson's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Kimberly Peterson enrolled in Medicare?

No. Kimberly Peterson has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Kimberly Peterson was last updated on November 5, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.