| Organization Name: | SOUTH METRO THERAPY LLC |
| NPI Number: | 1144691411 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NERGIS PETERSEN (THERAPIST) |
| Mailing Address: | 9202 202nd St W Ste 201 Lakeville |
| State: | MN US |
| Postal Code: | 550447917 |
| Phone Number: | 9525673399 |
| Fax Number: | |
| NPI Enumeration Date: | 10/13/2015 |
| NPI Last Update Date: | 10/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0850X |
| License Number: | CC00807 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Mental Health |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |