Individual provider Active NPI

Joseph Peterson, LMFT

  • Marriage & Family Therapist
  • Minneapolis, MN
National Provider Identifier
1760786180
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
3813 Issued in MN
Practice address
3333 University Ave SE
Minneapolis, MN 55414-3325
Phone
(612) 400-6170
NPI assigned
Dec 28, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2019

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 3813 MN Primary

Addresses

Primary practice location

3333 University Ave SE
Minneapolis, MN 55414-3325

Mailing address

3333 University Ave SE
Minneapolis, MN 55414-3325
Phone (612) 400-6170

Other practice location 1

1101 W Moana Ln
Suite 2
Reno, NV 89509-4775
Phone (775) 337-2394

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
I20240209002755 MN Practitioner - Marriage and Family Therapist 7315380938 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fraser Child and Family CenterGroup PAC ID 3971918772, 54 clinicians

Practice addresses (Care Compare)

2400 W 64TH St
Richfield, MN 55423-1001
Phone (612) 861-1688

9120 Springbrook Dr NW
Coon Rapids, MN 55433-5845
Phone (612) 767-7222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Fraser Child and Family Center CurrentSince Jan 1, 2024 Accepting new patients
Fraser PastSince Oct 6, 2019 Accepting new patients

Locations

9120 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 231-2590

3333 University Ave SE
Minneapolis, MN 55414
Phone (612) 253-1139

2400 W 64th St
Richfield, MN 55423
Phone (612) 767-5166

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1293494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569974400000",
    "number": "1760786180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 UNIVERSITY AVE SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554143325",
            "telephone_number": "612-400-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 UNIVERSITY AVE SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554143325",
            "telephone_number": "612-400-6170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 W Moana Ln",
            "address_2": "Suite 2",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895094775",
            "country_code": "US",
            "telephone_number": "775-337-2394",
            "fax_number": "775-337-9570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JOSEPH",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-28",
        "last_updated": "2019-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "3813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.