Individual provider Active NPI

Sharon Joyce Petersen, L.M.F.T.

  • Marriage & Family Therapist
  • Burnsville, MN
National Provider Identifier
1275593949
Registry record updated Mar 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
1251 Issued in MN
Practice address
11990 Portland Ave
Burnsville, MN 55337-1516
Phone
(952) 736-8393
Fax
(952) 479-7896
NPI assigned
Mar 25, 2006
Last updated
Mar 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 23, 2025

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 1251 MN Primary

Addresses

Primary practice location

11990 Portland Ave
Burnsville, MN 55337-1516

Mailing address

11990 Portland Ave
Burnsville, MN 55337-1516
Phone (952) 736-8393

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
I20240517001264 MN Practitioner - Marriage and Family Therapist 8123469418 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Heartland Counseling, LLCGroup PAC ID 6406297795, 2 clinicians

Practice addresses (Care Compare)

11990 Portland Ave
Burnsville, MN 55337-1516
Phone (612) 636-1107

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1251MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Heartland Counseling, LLC Marriage & Family Therapist CurrentSince Apr 3, 2024 Accepting new patients

Locations

11990 Portland Ave
Burnsville, MN 55337
Phone (612) 439-1100

190 S River Ridge Cir
Ste 209
Burnsville, MN 55337

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": "1143244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742688000000",
    "number": "1275593949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11990 PORTLAND AVE",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553371516",
            "telephone_number": "952-736-8393",
            "fax_number": "952-479-7896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11990 PORTLAND AVE",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553371516",
            "telephone_number": "952-736-8393",
            "fax_number": "952-479-7896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "SHARON",
        "middle_name": "JOYCE",
        "name_prefix": "Mrs.",
        "credential": "L.M.F.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-25",
        "last_updated": "2025-03-23",
        "certification_date": "2025-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "1251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

Verify at the official NPI Registry.