Provider Demographics
NPI:1982199717
Name:CAPPON, PETER J (LPC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:CAPPON
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 1:3413 TOMAHAWK DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1961
Mailing Address - Country:US
Mailing Address - Phone:616-202-8240
Mailing Address - Fax:
Practice Address - Street 1:3413 TOMAHAWK DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1961
Practice Address - Country:US
Practice Address - Phone:616-202-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016700101YP2500X
MI6401018523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional