Provider Demographics
NPI:1568639334
Name:GRUNNET, PETER CHARLES (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:CHARLES
Last Name:GRUNNET
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13705 HEATHER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3909
Mailing Address - Country:US
Mailing Address - Phone:952-432-1917
Mailing Address - Fax:612-861-3446
Practice Address - Street 1:1206 W 96TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2606
Practice Address - Country:US
Practice Address - Phone:952-884-4882
Practice Address - Fax:952-884-0284
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist