Active NPI
Joseph Petersen, BS, LADC
- Addiction (Substance Use Disorder) Counselor
- Albert Lea, MN
National Provider Identifier
1699143149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 302594
- Practice address
- 203 W Clark St
Albert Lea, MN 56007-2549 - Phone
- (507) 377-5484
- Fax
- (507) 377-5505
- NPI assigned
- Sep 14, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 302594 | MN | Primary |
Addresses
Primary practice location
203 W Clark St
Albert Lea, MN 56007-2549
Mailing address
723 N Elm Ave
Owatonna, MN 55060-1736
Phone (507) 676-7573
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302594 | MN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514246400000",
"number": "1699143149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "723 N ELM AVE",
"city": "OWATONNA",
"state": "MN",
"postal_code": "550601736",
"telephone_number": "507-676-7573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 W CLARK ST",
"city": "ALBERT LEA",
"state": "MN",
"postal_code": "560072549",
"telephone_number": "507-377-5484",
"fax_number": "507-377-5505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "JOSEPH",
"credential": "BS, LADC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-14",
"last_updated": "2017-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "302594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albert Lea, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.