Healthcare Provider Details

I. General information

NPI: 1790852812
Provider Name (Legal Business Name): ALIDA GEPPERT MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 STADIUM DR
KALAMAZOO MI
49008
US

IV. Provider business mailing address

2615 STADIUM DR
KALAMAZOO MI
49008
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-1651
  • Fax: 269-382-7078
Mailing address:
  • Phone: 269-343-1651
  • Fax: 269-382-7078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401007769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: