Organization
LIFE TRANSFORMATIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATA PETESON (OWNER/ADDICTION COUNSELOR)
(701) 640-8915
Entity
Organization
Contact information
Practice address
227 6TH ST N, BRECKENRIDGE, MN 56520-1503
(701) 640-8915
Mailing address
PO BOX 703, FERGUS FALLS, MN 56538-0703
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/31/2017
Last updated
06/16/2018
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