Provider Demographics
NPI:1336667815
Name:PEIFFER, CODY CHARLES (BT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:CHARLES
Last Name:PEIFFER
Suffix:
Gender:M
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 S ISABELLA RD APT UU16
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-7137
Mailing Address - Country:US
Mailing Address - Phone:989-331-1810
Mailing Address - Fax:
Practice Address - Street 1:4075 S ISABELLA RD APT UU16
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-7137
Practice Address - Country:US
Practice Address - Phone:989-331-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician