Healthcare Provider Details

I. General information

NPI: 1679392880
Provider Name (Legal Business Name): PEAK CREATIVE LEARNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W GRAND RIVER AVE STE A
OKEMOS MI
48864-1604
US

IV. Provider business mailing address

2222 W GRAND RIVER AVE STE A
OKEMOS MI
48864-1604
US

V. Phone/Fax

Practice location:
  • Phone: 810-262-0409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARMICHAELLE JOSEPH
Title or Position: OWNER
Credential: BCBA
Phone: 810-262-0409