Healthcare Provider Details

I. General information

NPI: 1942786314
Provider Name (Legal Business Name): PEACE OBETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 NW 3RD ST
GRAND RAPIDS MN
55744-2135
US

IV. Provider business mailing address

2310 NW 3RD ST
GRAND RAPIDS MN
55744-2135
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-2001
  • Fax:
Mailing address:
  • Phone: 218-327-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9152
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: