MEDICARE: MRS. SHARON JOYCE PETERSEN L.M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1251	MN

General Provider Information

NPI Number	:	1275593949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON JOYCE PETERSEN L.M.F.T.

Provider Business Mailing Address
First Line	:	11990 PORTLAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1516
Country	:	US
Telephone Number	:	952-736-8393
Fax Number	:	952-479-7896

Provider Business Practice Location Address
First Line	:	11990 PORTLAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1516
Country	:	US
Telephone Number	:	952-736-8393
Fax Number	:	952-479-7896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	03/23/2025

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