Individual provider Active NPI

Cassie Peterson, MS, LMFT

  • Marriage & Family Therapist
  • Mora, MN
National Provider Identifier
1255819371
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
4207 Issued in MN
Practice address
900 Old Farm Rd
Mora, MN 55051-4412
Phone
(320) 679-2438
Fax
(320) 679-6906
NPI assigned
Jul 31, 2018
Last updated
Jul 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 4207 MN Primary

Addresses

Primary practice location

900 Old Farm Rd
Mora, MN 55051-4412

Mailing address

900 Old Farm Rd
Mora, MN 55051-4412
Phone (320) 679-2438

Other practice location 1

820 Howe Ave Ste 108
Mora, MN 55051-1766
Phone (320) 679-2438

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250206002078 MN Practitioner - Marriage and Family Therapist 5092245050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Counseling Services IncGroup PAC ID 9537606967, 3 clinicians

Practice addresses (Care Compare)

900 Old Farm Rd
Mora, MN 55051-4412
Phone (320) 679-2438

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
4207MNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Counseling Services, Inc CurrentSince Jan 20, 2025 Accepting new patients

Locations

900 Old Farm Rd
Mora, MN 55051
Phone (320) 679-2438

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1255819371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 OLD FARM RD",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550514412",
            "telephone_number": "320-679-2438",
            "fax_number": "320-679-6906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 OLD FARM RD",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550514412",
            "telephone_number": "320-679-2438",
            "fax_number": "320-679-6906"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "820 Howe Ave Ste 108",
            "address_purpose": "LOCATION",
            "city": "Mora",
            "state": "MN",
            "postal_code": "550511766",
            "country_code": "US",
            "telephone_number": "320-679-2438",
            "fax_number": "320-679-6906",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CASSIE",
        "credential": "MS, LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-31",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "4207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mora, MN

Sources for this page

Verify at the official NPI Registry.