Provider Demographics
NPI:1164316089
Name:PETERSEN, CHANTEL YAUMAN (CSW)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:YAUMAN
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N 200 W STE 2
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-1303
Mailing Address - Country:US
Mailing Address - Phone:435-301-8969
Mailing Address - Fax:
Practice Address - Street 1:491 E RIVERSIDE DR STE 1B
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7053
Practice Address - Country:US
Practice Address - Phone:435-301-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7622840-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty