Provider Demographics
NPI:1477601615
Name:MCPEEK, PHILLIP A (MSW)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:A
Last Name:MCPEEK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 INDIANWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-1212
Mailing Address - Country:US
Mailing Address - Phone:248-693-1817
Mailing Address - Fax:
Practice Address - Street 1:455 BARCLAY CIR STE C-1
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4774
Practice Address - Country:US
Practice Address - Phone:248-852-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010010531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical