Organization
RESILIENT FUSION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATASHA PETERSON LPCC (OWNER)
(952) 210-2724
Entity
Organization
Contact information
Practice address
3662 POINTE PASS NW, PRIOR LAKE, MN 55372-4555
(952) 210-2724
Mailing address
3662 POINTE PASS NW, PRIOR LAKE, MN 55372-4555
(952) 210-2724
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/04/2024
Last updated
04/04/2024
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