Healthcare Provider Details

I. General information

NPI: 1750204236
Provider Name (Legal Business Name): PEYTON PLATTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 DEL MAR DR SW
WYOMING MI
49418-8870
US

IV. Provider business mailing address

1282 SAFFRON LN SE APT 3B
GRAND RAPIDS MI
49508-7350
US

V. Phone/Fax

Practice location:
  • Phone: 616-317-4807
  • Fax:
Mailing address:
  • Phone: 616-317-4807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6362010347
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: