Individual
DOUGLAS PETRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A. L.P.C.C.
Contact information
Practice address
2400 W 64TH ST, RICHFIELD, MN 55423
(612) 875-5996
Mailing address
2400 W 64TH ST, MINNEAPOLIS, MN 55423-1001
(612) 875-5996
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
896
MN
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
896
BLUE CROSS BLUE SHIELD
MN
Enumeration date
09/30/2014
Last updated
06/18/2018
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