Provider Demographics
NPI:1245747609
Name:PEAK THERAPY LLC
Entity Type:Organization
Organization Name:PEAK THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:THERAPIST, MA
Authorized Official - Phone:734-776-7738
Mailing Address - Street 1:18270 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3287
Mailing Address - Country:US
Mailing Address - Phone:734-776-7738
Mailing Address - Fax:
Practice Address - Street 1:18270 CASCADE DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3287
Practice Address - Country:US
Practice Address - Phone:734-776-7738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014963261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health