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KATHLEENJO MARIE PETERSON LADC
NPI 1972160133
Counselor - Mental Health in Greeley, CO

Active since May 23, 2019PECOS Enrolled
1300 N 17TH AVE, GREELEY, CO 80631(970) 347-2120 Get Directions Write a Review

NPPES record last updated: May 23, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Kathleenjo Marie Peterson Ladc NPPES

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

KATHLEENJO MARIE PETERSON LADC (NPI 1972160133) is an individual mental health provider in Greeley, Colorado and active in the NPI registry since May 2019. She is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1972160133
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameKATHLEENJO MARIE PETERSONCredential: LADC
Location Address1300 N 17TH AVEGreeley, CO 80631-9584
Mailing Address1300 N 17th AveGreeley, CO 80631-9584 · (970) 347-2120
Phone(970) 347-2120
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateMay 23, 2019
✔ NPI 1972160133 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
1300 N 17TH AVE, Greeley, CO 80631
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kathleenjo Marie Peterson Ladc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4981173580
PECOS Enrollment IDI20260513000599
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kathleenjo Peterson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Emily Program P C
663 mi
Mental Health (Including Community Mental Health Center)
2265 COMO AVENUE, SUITE 100
St Paul, MN 55108
  • Reassigned Medicare billing, Minnesota enrollment
  • 121 clinicians in this Medicare group
NPI 1528165065 (866) 364-5977

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

JENNIFER KEHL LCSW
Social Worker
1300 N 17TH AVE
GREELEY, CO 80631
Weld County (970) 347-2120
SCOTT D CLAWSON CAC III
Counselor (Addiction (Substance Use Disorder))
1300 N 17TH AVE
GREELEY, CO 80631
Weld County (970) 347-2120
JAKOB BEDNARCHUK
Counselor (Mental Health)
1300 N 17TH AVE
GREELEY, CO 80631
Weld County (970) 347-2120
DAVID WAYNE FAVER RN
Registered Nurse (Psychiatric/Mental Health)
1300 N 17TH AVE
GREELEY, CO 80631
Weld County (970) 347-2120
MADISON EVANS
Peer Specialist
1300 N 17TH AVE
GREELEY, CO 80631
Weld County (970) 347-2120
MEGHAN HOPKINS
Peer Specialist
1300 N 17TH AVE
GREELEY, CO 80631
Weld County (970) 347-2120
EVELYN FIDELA ROBLES-GAMBOA
Peer Specialist
1300 N 17TH AVE
GREELEY, CO 80631
Weld County (970) 347-2120
ALEXANDRA SMITH
Student in an Organized Health Care Education/Training Program
1300 N 17TH AVE
GREELEY, CO 80631
Weld County (970) 347-2120

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 Kathleenjo Peterson's NPI number?

The NPI number for Kathleenjo Peterson is 1972160133. It was assigned to this individual provider in the NPPES registry on May 23, 2019.

Where is Kathleenjo Peterson located?

Kathleenjo Peterson practices at 1300 N 17th Ave, Greeley, CO 80631. The listed phone number is (970) 347-2120.

What is Kathleenjo Peterson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Kathleenjo Peterson enrolled in Medicare?

Yes. Kathleenjo Peterson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kathleenjo Peterson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kathleenjo Peterson reassigns Medicare benefits to Emily Program P C (St Paul, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kathleenjo Peterson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kathleenjo Peterson was last updated on May 23, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.