Organization
SOUTH METRO THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NERGIS PETERSEN (THERAPIST)
(952) 567-3399
Entity
Organization
Contact information
Practice address
9202 202ND ST W STE 201, LAKEVILLE, MN 55044-7917
(952) 567-3399
Mailing address
17898 179TH TRL W, LAKEVILLE, MN 55044-7248
(952) 250-4072
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
CC00807
MN
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
CC00807
MN
Other
Enumeration date
10/13/2015
Last updated
10/13/2015
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