KATHERINE ANN PETERSON MA, LPCC, LADC - NPI 1336997063

Q: What is Katherine Peterson's NPI number?

The NPI number for Katherine Peterson is 1336997063. It was assigned to this individual provider in the NPPES registry on May 8, 2024. The provider is also known as Katherine Ann Christian Ma, Lpcc, Ladc.

Q: What is Katherine Peterson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

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About Katherine Ann Peterson Ma, Lpcc, Ladc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KATHERINE ANN PETERSON MA, LPCC, LADC (NPI 1336997063) is an individual professional provider in St Louis Park, Minnesota, licensed in Minnesota (4403) and active in the NPI registry since May 2024. She is enrolled in Medicare PECOS, maintains a secondary practice location in Minneapolis, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1336997063

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameKATHERINE ANN PETERSONCredential: MA, LPCC, LADC

Location Address1155 FORD RD STE BSt Louis Park, MN 55426-1115

Mailing Address4240 Park Glen RdSt Louis Park, MN 55416-5427 · (612) 925-6033 · Fax (612) 925-8496

Phone(952) 378-1800

Fax(952) 378-1714

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateMay 8, 2024

Last NPPES UpdateJune 4, 20263 updates tracked since enumeration

NPPES CertifiedJune 4, 2026

✔ NPI 1336997063 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in MN · 4403

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 305945 (MN)

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 4403 (MN)

1155 FORD RD STE B, St Louis Park, MN 55426

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Other Names 1

Former Name (1)Katherine Ann Christian Ma, Lpcc, Ladc

Secondary Practice Location 1

Location 14027 County Road 25Minneapolis, MN 55416-2629 · Phone (612) 925-6033 · Fax (612) 925-8496

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners, Sanford Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Katherine Ann Peterson Ma, Lpcc, Ladc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8820596331

PECOS Enrollment IDI20250813000597

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHLEEN MEREDITH HOLDEN MSN, PMHNP-BC, ARNP

Nurse Practitioner (Psychiatric/Mental Health)