Healthcare Provider Details

I. General information

NPI: 1245747609
Provider Name (Legal Business Name): PEAK THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18270 CASCADE DR
NORTHVILLE MI
48168-3287
US

IV. Provider business mailing address

18270 CASCADE DR
NORTHVILLE MI
48168-3287
US

V. Phone/Fax

Practice location:
  • Phone: 734-776-7738
  • Fax:
Mailing address:
  • Phone: 734-776-7738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6401014963
License Number StateMI

VIII. Authorized Official

Name: JEANINE M MADSEN
Title or Position: OWNER
Credential: THERAPIST, MA
Phone: 734-776-7738