Organization
PETERSON COUNSELING AND SUPERVISION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA ANN PETERSON LICSW (PARTNER)
(952) 808-6848
Entity
Organization
Contact information
Practice address
1585 THOMAS CENTER DR, 104, EAGAN, MN 55122-3007
(952) 808-6848
Mailing address
1585 THOMAS CENTER DR, 104, EAGAN, MN 55122-3007
(952) 808-6848
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
20365
MN
251S00000X
Community/Behavioral Health Agency
20366
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06202
—
MN
Enumeration date
04/05/2012
Last updated
11/13/2013
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