Individual
TAMMY MARIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LADC, LPCC
Contact information
Practice address
4638 VICTOR PATH STE 900, HUGO, MN 55038-4732
(651) 364-3839
Mailing address
27860 LACY AVE, CHISAGO CITY, MN 55013
(651) 410-8912
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC03846
MN
Other
Enumeration date
03/22/2022
Last updated
06/09/2023
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