DR. JOHN ANTHONY PETERSEN PSY.D.
NPI 1851491526
Psychologist in South Bend, IN

Active since September 23, 2006
922 E WAYNE ST # 205, SOUTH BEND, IN 46617(574) 280-8199 Get Directions Write a Review

NPPES record last updated: December 1, 2018. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Dr. John Anthony Petersen Psy.d. NPPES

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

DR. JOHN ANTHONY PETERSEN PSY.D. (NPI 1851491526) is an individual psychologist in South Bend, Indiana, licensed in Indiana (20041594A) and active in the NPI registry since September 2006. He maintains a secondary practice location in South Bend.

NPPES Registry Identity

NPI1851491526
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. JOHN ANTHONY PETERSENCredential: PSY.D.
Location Address922 E WAYNE ST # 205South Bend, IN 46617-3024
Mailing Address208 E Angela BlvdSouth Bend, IN 46617-1202 · (574) 288-7919 · Fax (574) 280-8199
Sole ProprietorYes
Enumeration DateSeptember 23, 2006
Last NPPES UpdateDecember 1, 2018
NPI 1851491526 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in IN · 20041594A
Definition

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

922 E WAYNE ST # 205, South Bend, IN 46617

Secondary Practice Location 1

Location 1115 S Saint Peter StSouth Bend, IN 46617-2912 · Phone (574) 280-8199 · Fax (574) 280-8199

Other Identifiers 1

Medicaid200347860AIN

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 John Petersen's NPI number?

The NPI number for John Petersen is 1851491526. It was assigned to this individual provider in the NPPES registry on September 23, 2006.

Where is John Petersen located?

John Petersen practices at 922 E Wayne St # 205, South Bend, IN 46617. The listed phone number is (574) 280-8199.

What is John Petersen's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

When was this NPI record last updated?

The NPPES record for John Petersen was last updated on December 1, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.