Individual
MICHAEL ROBERT PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
522 4TH ST S, STILLWATER, MN 55082-4966
(612) 220-6038
Mailing address
6201 SAINT CROIX TRL N APT 119, OAK PARK HEIGHTS, MN 55082-6966
(612) 220-6038
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1565
MI
Other
Enumeration date
09/09/2013
Last updated
01/07/2020
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