Individual
BECKY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8122 113TH AVE N, CHAMPLIN, MN 55316-3770
(612) 532-7411
Mailing address
8122 113TH AVE N, CHAMPLIN, MN 55316-3770
(612) 532-7411
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/02/2014
Last updated
12/02/2014
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