Provider Demographics
NPI:1780194365
Name:PEERY, MATEAUR
Entity Type:Individual
Prefix:MR
First Name:MATEAUR
Middle Name:
Last Name:PEERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 TORRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-5442
Mailing Address - Country:US
Mailing Address - Phone:419-704-0756
Mailing Address - Fax:
Practice Address - Street 1:3518 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4114
Practice Address - Country:US
Practice Address - Phone:419-241-2182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)