Provider Demographics
NPI:1033847470
Name:ALISHA PECK, LMSW
Entity Type:Organization
Organization Name:ALISHA PECK, LMSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK-MUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-330-2303
Mailing Address - Street 1:668 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-9129
Mailing Address - Country:US
Mailing Address - Phone:231-330-2303
Mailing Address - Fax:
Practice Address - Street 1:668 STATE ST
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-9129
Practice Address - Country:US
Practice Address - Phone:231-330-2303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIVS0047322Medicaid