Provider Demographics
NPI:1760550057
Name:MID-MICHIGAN FAMILY, LTD.
Entity Type:Organization
Organization Name:MID-MICHIGAN FAMILY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PETRAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:989-773-9600
Mailing Address - Street 1:615 E WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2767
Mailing Address - Country:US
Mailing Address - Phone:989-773-9600
Mailing Address - Fax:989-772-3387
Practice Address - Street 1:615 E WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2767
Practice Address - Country:US
Practice Address - Phone:989-773-9600
Practice Address - Fax:989-772-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty