Healthcare Provider Details

I. General information

NPI: 1982251922
Provider Name (Legal Business Name): LAURA LINN PETERS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA LINN CLOVER

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12918 63RD AVE N
MAPLE GROVE MN
55369-6001
US

IV. Provider business mailing address

16400 43RD AVE N
PLYMOUTH MN
55446-2435
US

V. Phone/Fax

Practice location:
  • Phone: 763-210-9966
  • Fax:
Mailing address:
  • Phone: 612-655-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC05375
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: