Individual
MRS. EILEEN MARIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
207 JEFFERSON BLVD, BIG LAKE, MN 55309-4667
(763) 367-6080
(763) 263-7897
Mailing address
3833 COON RAPIDS BLVD NW, SUITE 120, COON RAPIDS, MN 55433-2643
(763) 767-3350
(763) 767-0912
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
3566
MN
Other
Enumeration date
07/29/2016
Last updated
10/04/2018
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