Peterson Counseling and Supervision, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

20365 Issued in MN

Legal business name

PETERSON COUNSELING AND SUPERVISION, LLC

Practice address

1585 Thomas Center Dr
104
Eagan, MN 55122-3007

Phone

(952) 808-6848

NPI assigned

Apr 5, 2012

Organization subpart

No

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

Authorized official

Name

Jessica Ann Peterson, LICSW

Title

Partner

Phone

(952) 808-6848

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384300800000",
    "number": "1285990002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1585 THOMAS CENTER DR",
            "address_2": "104",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551223007",
            "telephone_number": "952-808-6848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1585 THOMAS CENTER DR",
            "address_2": "104",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551223007",
            "telephone_number": "952-808-6848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON COUNSELING AND SUPERVISION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-05",
        "last_updated": "2013-11-13",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "952-808-6848",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "20365",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "20366",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06202",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Todd Perry, A-GNP-C
• Elizabeth Ann Pesek, MD
• Amber Petereck
• John Robert Petersen, DDS
• Sheri Lynn Petersen, LPCC
• Anna Peterson
• Ashley Julian Peterson
• Gerald Frederick Peterson, MD
• Jessica Ann Peterson, LICSW, CSW-PIP
• Jimmie Ray Peterson

• Community/Behavioral Health Agency in Eagan, MN
• Providers in Eagan, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.