Provider Demographics
NPI:1275593949
Name:PETERSEN, SHARON JOYCE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:JOYCE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 S RIVER RIDGE CIR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1627
Mailing Address - Country:US
Mailing Address - Phone:952-736-8393
Mailing Address - Fax:952-736-8375
Practice Address - Street 1:190 S RIVER RIDGE CIR
Practice Address - Street 2:SUITE 209
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1627
Practice Address - Country:US
Practice Address - Phone:952-736-8393
Practice Address - Fax:952-736-8375
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1251106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist