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General NPI Number Information
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NPI Number | 1730905571
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Entity Type | Organization
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Legal Business Name | NICOLE PETERSEN WELL-BEING LLC
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 3815 BRYANT AVE S APT 6
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City | MINNEAPOLIS
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State | MN
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Zip | 55409-1061
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Country | US
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Telephone | 612-559-9964
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Fax |
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Provider Business Mailing Address
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Address Line | 7505 TERRITORY PASS
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City | LAKEVILLE
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State | MN
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Zip | 55044-6118
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Country | US
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Telephone | 612-559-9964
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | NICOLE PETERSEN
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Credential | LPCC
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Telephone | 612-559-9964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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