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General NPI Number Information
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NPI Number | 1568639334
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Entity Type | Individual
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Provider Name | PETER CHARLES GRUNNET M.A., L.M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 1206 W 96TH ST
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2606
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Country | US
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Telephone | 952-884-4882
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Fax | 952-884-0284
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Provider Business Mailing Address
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Address Line | 13705 HEATHER HILLS DR
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City | BURNSVILLE
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State | MN
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Zip | 55337-3909
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Country | US
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Telephone | 952-432-1917
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Fax | 612-861-3446
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1375
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License Number State | MN
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