Provider Demographics
NPI:1548569304
Name:PETERSON, ERIN C (LMFT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:C
Last Name:PETERSON
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 1:5200 WILLSON RD STE 307
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1344
Mailing Address - Country:US
Mailing Address - Phone:651-216-7023
Mailing Address - Fax:952-209-3292
Practice Address - Street 1:5200 WILLSON RD STE 307
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1344
Practice Address - Country:US
Practice Address - Phone:651-216-7023
Practice Address - Fax:952-209-3292
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2106106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist