Provider Demographics
NPI:1255819371
Name:PETERSON, CASSIE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-4412
Mailing Address - Country:US
Mailing Address - Phone:320-679-2438
Mailing Address - Fax:320-679-6906
Practice Address - Street 1:900 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-4412
Practice Address - Country:US
Practice Address - Phone:320-679-2438
Practice Address - Fax:320-679-6906
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist