MEDICARE: PETER GILES LPC, CAADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		MI
2	101YP2500X	Professional Counselor		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649631789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER GILES LPC, CAADC

Provider Business Mailing Address
First Line	:	26711 WOODWARD AVE STE LL3
Second Line	:
City	:	HUNTINGTON WOODS
State	:	MI
Zip	:	48070-1370
Country	:	US
Telephone Number	:	901-485-2431
Fax Number	:

Provider Business Practice Location Address
First Line	:	26711 WOODWARD AVE STE LL3
Second Line	:
City	:	HUNTINGTON WOODS
State	:	MI
Zip	:	48070-1370
Country	:	US
Telephone Number	:	901-485-2431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2016
Last Update Date	:	01/21/2021

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