Provider Demographics
NPI:1932803319
Name:PETERSEN, HEATHER MARIE (LPCC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 BELTRAMI AVE NW SUITE 9
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3343
Mailing Address - Country:US
Mailing Address - Phone:218-407-4247
Mailing Address - Fax:
Practice Address - Street 1:522 BELTRAMI AVE NW STE 9
Practice Address - Street 2:SUITE 9
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601
Practice Address - Country:US
Practice Address - Phone:218-407-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN03746101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health