Provider Demographics
NPI:1043765662
Name:PECK-MUMA, ALISHA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:PECK-MUMA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:MARIE
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
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:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010938911041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical