Provider Demographics
NPI:1619206513
Name:PROFESSIONAL PEER SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL PEER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDIGARE
Authorized Official - Suffix:
Authorized Official - Credentials:CPSS
Authorized Official - Phone:517-316-9033
Mailing Address - Street 1:316 S MARTIN L KING BLVD
Mailing Address - Street 2:# 2
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 S MARTIN L KING BLVD
Practice Address - Street 2:# 2
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915
Practice Address - Country:US
Practice Address - Phone:517-316-9033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health