Individual
MICHELLE C PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS LMFT
Contact information
Practice address
7600 PARKLAWN AVE, EDINA, MN 55435
(612) 203-2961
(952) 831-0033
Mailing address
7600 PARKLAWN AVENUE,, 380, EDINA, MN 55435-4300
(612) 203-2961
(952) 831-0033
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1315
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639343783
ORGANIZATIONAL NPI
—
01
—
918142300
MEDICAL ASSISTANCE
—
05
—
918142300
—
MN
01
—
990991045225
PREFERRED ONE
MN
Enumeration date
04/08/2006
Last updated
07/21/2022
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