Healthcare Provider Details

I. General information

NPI: 1174872881
Provider Name (Legal Business Name): AIMEE LEAH PETERS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1662 E CENTRE AVE
PORTAGE MI
49002-4496
US

IV. Provider business mailing address

1662 E CENTRE AVE
PORTAGE MI
49002-4496
US

V. Phone/Fax

Practice location:
  • Phone: 269-321-8564
  • Fax: 269-321-8641
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401012494
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006494
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: