Healthcare Provider Details

I. General information

NPI: 1760346324
Provider Name (Legal Business Name): PETUR EINARSSON MA, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 PLEASANT VALLEY RD
CENTER CITY MN
55012-9640
US

IV. Provider business mailing address

PO BOX 105
LINDSTROM MN
55045-0105
US

V. Phone/Fax

Practice location:
  • Phone: 651-213-4524
  • Fax:
Mailing address:
  • Phone: 612-232-4448
  • Fax: 612-232-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number306895
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: