Individual
MS. MATA MARIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW, LADC
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
(701) 640-8915
(218) 643-7175
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301596
MN
104100000X
Social Worker
15452
MN
Other
Enumeration date
04/09/2013
Last updated
05/21/2020
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