Provider Demographics
NPI:1508203472
Name:PETER ZOUTENDYK, LMSW
Entity Type:Organization
Organization Name:PETER ZOUTENDYK, LMSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOUTENDYK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-947-0511
Mailing Address - Street 1:814 S GARFIELD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2401
Mailing Address - Country:US
Mailing Address - Phone:231-947-0511
Mailing Address - Fax:231-947-6066
Practice Address - Street 1:814 S GARFIELD AVE STE C
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2401
Practice Address - Country:US
Practice Address - Phone:231-947-0511
Practice Address - Fax:231-947-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010051451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty