Provider Demographics
NPI:1093881740
Name:STONEY CREEK PSYCHOLOGICAL CONSULTING PLLC
Entity Type:Organization
Organization Name:STONEY CREEK PSYCHOLOGICAL CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPEEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-969-0176
Mailing Address - Street 1:455 BARCLAY CIR
Mailing Address - Street 2:STE C1
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4774
Mailing Address - Country:US
Mailing Address - Phone:248-969-0176
Mailing Address - Fax:248-853-0015
Practice Address - Street 1:455 BARCLAY CIR
Practice Address - Street 2:STE C1
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4774
Practice Address - Country:US
Practice Address - Phone:248-969-0176
Practice Address - Fax:248-853-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007338103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty