Organization
GENUINE THERAPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRENTON JON PETERSON MA, LMFT, LADC (OWNER)
(763) 712-1903
Entity
Organization
Contact information
Practice address
630 E MAIN ST, ANOKA, MN 55303
(763) 712-1903
(763) 712-1917
Mailing address
630 E MAIN ST, ANOKA, MN 55303-2527
(763) 712-1903
(763) 712-1917
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1117
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
857665100
—
MN
Enumeration date
06/08/2007
Last updated
07/23/2018
Update your record
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