Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jon Walter Petersen, MA, MED, LPCC, CMHC

Individual provider Mental Health Counselor · NPI 1831735141

Jon Walter Petersen, MA, MED, LPCC, CMHC is a Mental Health Counselor in St Louis Park, Minnesota. Qualified in 2012, 14 years ago. Licensed in Minnesota and Utah.

Years since qualifying
14
Licensed in
MN, UT
In the registry since
2019
Specialties on file
2
What do these letters mean?
MA — Master of Arts
A graduate arts degree.
MED — Master of Education
A graduate education degree, written M.Ed.
LPCC — Licensed Professional Clinical Counselor
The title some states use for a licensed clinical counsellor.

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Practice location Address checks out

1155 Ford Rd Ste B
St Louis Park, MN 55426-1115
Phone: (952) 378-1800
Fax: (952) 378-1714
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 2463 (MN)
Mental Health Counselor Taxonomy 101YM0800X · Licence 12348521-6004 (UT)

Record details

NPI number1831735141
Entity typeIndividual (Type 1)
GenderMale
Credentials MA , MED , LPCC , CMHC
Sole proprietorNo
NPI enumeratedNovember 21, 2019
Last updated in NPPESJune 13, 2025
Certification dateJune 13, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Accepts Medicare assignment Not indicated

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