JON WALTER PETERSEN MA, M.ED, LPCC, CMHC
NPI 1831735141
Counselor - Professional in St Louis Park, MN

Q: What is Jon Petersen's NPI number?

The NPI number for Jon Petersen is 1831735141. It was assigned to this individual provider in the NPPES registry on November 21, 2019.

Q: What is Jon Petersen's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jon Petersen was last updated on June 13, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since November 21, 2019PECOS Enrolled

1155 FORD RD STE B, ST LOUIS PARK, MN 55426(952) 378-1800(952) 378-1714 Get Directions Write a Review

NPPES record last updated: June 13, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 13, 2025, Nov 21, 2019 (2 updates tracked since 2019).

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About Jon Walter Petersen Ma, M.ed, Lpcc, Cmhc NPPES

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

JON WALTER PETERSEN MA, M.ED, LPCC, CMHC (NPI 1831735141) is an individual professional provider in St Louis Park, Minnesota, licensed in Minnesota (2463) and active in the NPI registry since November 2019. He is enrolled in Medicare PECOS and is a graduate of Other (2012).

NPPES Registry Identity

NPI1831735141

Entity TypeIndividualMale

Primary Taxonomy101YP2500X

Provider Legal NameJON WALTER PETERSENCredential: MA, M.ED, LPCC, CMHC

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 2012

Enumeration DateNovember 21, 2019

Last NPPES UpdateJune 13, 20252 updates tracked since enumeration

NPPES CertifiedJune 13, 2025

✔ NPI 1831735141 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in MN · 2463

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 12348521-6004 (UT)

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

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.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)

Jon Walter Petersen Ma, M.ed, Lpcc, Cmhc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3971018458

PECOS Enrollment IDI20250714003341

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.

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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)