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General NPI Number Information
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NPI Number | 1083303689
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Entity Type | Individual
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Provider Name | MISTY LYNN PEETE LLC
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Gender | Female
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 26300 OUTER DR
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City | LINCOLN PARK
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State | MI
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Zip | 48146-2019
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Country | US
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Telephone | 734-968-0307
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Fax |
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Provider Business Mailing Address
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Address Line | 26810 COLGATE ST
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City | INKSTER
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State | MI
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Zip | 48141-3108
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Country | US
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Telephone | 734-968-0307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | MI
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