Provider Demographics
NPI:1528212248
Name:PETERS, MATTHEW DAVID (LPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:PETERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DENBY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-5226
Mailing Address - Country:US
Mailing Address - Phone:586-945-7145
Mailing Address - Fax:586-464-0184
Practice Address - Street 1:150 DENBY ST
Practice Address - Street 2:SUITE A
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-5226
Practice Address - Country:US
Practice Address - Phone:586-945-7145
Practice Address - Fax:586-464-0184
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional