Healthcare Provider Details

I. General information

NPI: 1053275768
Provider Name (Legal Business Name): PEGGY BEATTIE MA LPCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 EXCELSIOR BLVD STE 130
ST LOUIS PARK MN
55416-3049
US

IV. Provider business mailing address

5009 EXCELSIOR BLVD STE 130
ST LOUIS PARK MN
55416-3049
US

V. Phone/Fax

Practice location:
  • Phone: 888-203-1508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: PEGGY BEATTIE
Title or Position: PRACTICE OWNER
Credential: LPCC
Phone: 888-203-1508