Provider Demographics
NPI:1154109544
Name:PETERS, COURTNEY M (LPC-S, LAPC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:PETERS
Suffix:
Gender:F
Credentials:LPC-S, LAPC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:M
Other - Last Name:FOLDESI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1615 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5372
Mailing Address - Country:US
Mailing Address - Phone:701-795-8550
Mailing Address - Fax:
Practice Address - Street 1:211 ARNOLD AVE N
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-1827
Practice Address - Country:US
Practice Address - Phone:701-795-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02875101YP2500X
ND1325-9-1-23A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional