Healthcare Provider Details

I. General information

NPI: 1275540676
Provider Name (Legal Business Name): DAVID PETTS M.A.,L.P.C.,L.L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 HOLIDAY TER
KALAMAZOO MI
49009-2196
US

IV. Provider business mailing address

10186 ROSEMARY LN
KALAMAZOO MI
49009-9369
US

V. Phone/Fax

Practice location:
  • Phone: 269-372-4140
  • Fax: 269-372-0390
Mailing address:
  • Phone: 269-615-3064
  • Fax: 269-372-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number100826
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008652
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: