Provider Demographics
NPI:1285008011
Name:PETERSON, RACHAEL (MS LPC LADC CCTP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS LPC LADC CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-0061
Mailing Address - Country:US
Mailing Address - Phone:608-332-3490
Mailing Address - Fax:
Practice Address - Street 1:570 BAVARIA LN
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-4597
Practice Address - Country:US
Practice Address - Phone:608-332-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304016101YA0400X
MN1394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)