Organization
OPTIOVILLAGE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRENTON JON PETERSON MA, LMFT (CLINICAL DIRECTOR)
(763) 712-1903
Entity
Organization
Contact information
Practice address
630 E MAIN ST, ANOKA, MN 55303-2527
(763) 712-1903
(763) 712-1917
Mailing address
630 EAST MAIN ST., ANOKA, MN 55303
(763) 712-1903
(763) 712-1917
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
MN
Other
Enumeration date
05/14/2015
Last updated
05/14/2015
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