Provider Demographics
NPI:1528540572
Name:PEASE, GERRED DOUGLAS (LMSW, CAADC)
Entity Type:Individual
Prefix:
First Name:GERRED
Middle Name:DOUGLAS
Last Name:PEASE
Suffix:
Gender:M
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 E PATRICK RD APT 106
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-6549
Mailing Address - Country:US
Mailing Address - Phone:989-495-3688
Mailing Address - Fax:
Practice Address - Street 1:33 WHITE TAIL CREEK RD STE 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5896
Practice Address - Country:US
Practice Address - Phone:989-220-3060
Practice Address - Fax:989-220-3409
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011151701041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical