Active NPI
Caleb Petersen, LAMFT
- Marriage & Family Therapist
- Shoreview, MN
National Provider Identifier
1285528695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 4635
- Practice address
- 3940 Lexington Ave. N.
Shoreview, MN 55126 - Phone
- (651) 379-3401
- NPI assigned
- Jun 9, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 4635 | MN | Primary |
Addresses
Primary practice location
3940 Lexington Ave. N.
Shoreview, MN 55126
Mailing address
3940 Lexington Ave. N.
Shoreview, MN 55126
Phone (651) 379-3401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4635 | MN | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749427200000",
"number": "1285528695",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3940 LEXINGTON AVE. N.",
"city": "SHOREVIEW",
"state": "MN",
"postal_code": "55126",
"telephone_number": "651-379-3401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3940 LEXINGTON AVE. N.",
"city": "SHOREVIEW",
"state": "MN",
"postal_code": "55126",
"telephone_number": "651-379-3401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "CALEB",
"credential": "LAMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-06-09",
"last_updated": "2025-06-09",
"certification_date": "2025-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "4635",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shoreview, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.