TAMMY MARIE PETERSON (MA, LADC, LPCC) – Counselor, NPI 1174272553

TAMMY MARIE PETERSON (MA, LADC, LPCC) is a healthcare provider. based in Chisago city, Minnesota. specializing in MENTAL HEALTH COUNSELOR. They hold the professional credentials MA, LADC, LPCC. They hold a License No. CC03846 (MN). The NPI Number for TAMMY MARIE PETERSON (MA, LADC, LPCC) is 1174272553

Main info

Female
6 Years Of Experience
Accepts Medicare Assignment
Name
TAMMY MARIE PETERSON (MA, LADC, LPCC)
NPI
1174272553
Phone
(651) 410-8912
Address
27860 LACY AVE
Enumeration Date
22 March 2022
Last Update Date
9 June 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6513643839
Graduation Year
2020 (6 years ago)
PAC ID
8527418011
Group Practice PAC ID
6406752492
Professional Enrollment ID
I20231226000491
Address ID
MN550384732HU4638XPATH302
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience37
Completeness75
Years active:4State licenses:1Digital endpointsOther names

1,813 MENTAL HEALTH COUNSELOR in MN

Provider Addresses for TAMMY MARIE PETERSON (MA, LADC, LPCC)

  • 27860 LACY AVE

    CHISAGO CITY, MN 55013

    Phone: (651) 410-8912

    Type: Mailing

  • 4638 VICTOR PATH STE 900

    HUGO, MN 550384732

    Phone: (651) 364-3839

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2023-12-26

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20231226000491IMental Health CounselorMNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55013)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6406752492View full group profile
NameSpecialtyState
-GA
Mental Health CounselorMN
Marriage And Family TherapistMN
Clinical PsychologistMN
Mental Health CounselorMN
Clinical PsychologistMN
Mental Health CounselorMN
Mental Health CounselorMN
Mental Health CounselorMN
-MN

Reviews

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Frequently asked questions

Is TAMMY MARIE PETERSON (MA, LADC, LPCC) listed with a National Provider Identifier?
Yes — TAMMY MARIE PETERSON (MA, LADC, LPCC) has NPI 1174272553 on file in the registry.
Is there an active status for TAMMY MARIE PETERSON (MA, LADC, LPCC)?
For scheduling context, TAMMY MARIE PETERSON (MA, LADC, LPCC) is shown as active in the registry.
What expertise is attributed to TAMMY MARIE PETERSON (MA, LADC, LPCC)?
TAMMY MARIE PETERSON (MA, LADC, LPCC)'s specialty line reads Counselor. Clinical services aligned with this taxonomy classification.
Where in Minnesota is TAMMY MARIE PETERSON (MA, LADC, LPCC) registered?
Use Chisago City, Minnesota as the headline location for TAMMY MARIE PETERSON (MA, LADC, LPCC) here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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