Individual ProviderMichael Robert PetersonCounselorBehavioral Health & Social Service ProvidersPractice Address522 4th St S, Stillwater, MN 55082-4966(612) 220-6038PECOS EnrollmentBased on the most recent information from CMS, provider Michael Robert Peterson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1033544119Provider TypeIndividualFull NamePeterson, Michael RobertCredentialLMFTGenderMaleSole ProprietorYesEnumeration Date9/9/2013Last Updated1/7/2020Contact InformationPractice LocationPractice Address522 4th St S, Stillwater, MN 55082-4966Phone(612) 220-6038FaxUnlisted FaxMailing LocationMailing Address6201 Saint Croix Trl N Apt 119, Oak Park Heights, MN 55082-6966Phone(612) 220-6038FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense1565Michigan