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NPI Code Detail

MEDICARE: AMANDA FLOWERS PETERSON

MEDICARE: AMANDA FLOWERS PETERSON
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1295554004
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA FLOWERS PETERSON
Provider Business Mailing Address
First Line : 9051 DEGLER CIR
Second Line :
City : CHANHASSEN
State : MN
Zip : 55317-4836
Country : US
Telephone Number : 530-276-1716
Fax Number :
Provider Business Practice Location Address
First Line : 905 JEFFERSON AVE STE 300
Second Line :
City : SAINT PAUL
State : MN
Zip : 55102-4740
Country : US
Telephone Number : 612-562-6167
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2024
Last Update Date : 10/11/2024

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