Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Russell Henry Peterson, MS

Individual provider Mental Health Counselor · NPI 1093879637

Mr. Russell Henry Peterson, MS is a Mental Health Counselor in Idaho Falls, Idaho. Qualified in 1997, 29 years ago. Practices with John D Perovich PSYD PLLC, a 4-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
29
Licensed in
ID
In the registry since
2006
What do these letters mean?
MS — Master of Science
A graduate science degree.

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Practice location Address checks out

2375 E Sunnyside Rd Ste C
Idaho Falls, ID 83404-8280
Phone: (208) 529-5777
Fax: (208) 529-5778
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence LCPC-3125 (ID)

Record details

NPI number1093879637
Entity typeIndividual (Type 1)
GenderMale
Credentials MS
Sole proprietorNo
NPI enumeratedDecember 20, 2006
Last updated in NPPESJuly 8, 2007

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 1997 (29 years in practice)
Group practice John D Perovich Psyd Pllc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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