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General NPI Number Information
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NPI Number | 1528212248
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Entity Type | Individual
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Provider Name | MATTHEW DAVID PETERS LPC
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Gender | Male
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Dates
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Enumeration Date | 11/07/2008
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 150 DENBY ST SUITE A
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City | ROMEO
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State | MI
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Zip | 48065-5226
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Country | US
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Telephone | 586-945-7145
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Fax | 586-464-0184
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Provider Business Mailing Address
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Address Line | 150 DENBY ST SUITE A
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City | ROMEO
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State | MI
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Zip | 48065-5226
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Country | US
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Telephone | 586-945-7145
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Fax | 586-464-0184
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401007040
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License Number State | MI
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