Provider Demographics
NPI:1437492337
Name:PETERSON, DEBORAH (LPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 RIVER ST N STE 109
Mailing Address - Street 2:PO BOX 752
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8266
Mailing Address - Country:US
Mailing Address - Phone:612-584-1153
Mailing Address - Fax:763-972-8808
Practice Address - Street 1:265 RIVER ST N STE 109
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8266
Practice Address - Country:US
Practice Address - Phone:612-584-1153
Practice Address - Fax:763-972-8808
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPC 01254101YM0800X
MN799101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health