Provider Demographics
NPI:1700933223
Name:LAUBER, PETER HERMANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:HERMANN
Last Name:LAUBER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 WESTMINSTER WAY
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7730
Mailing Address - Country:US
Mailing Address - Phone:517-575-0771
Mailing Address - Fax:517-339-4035
Practice Address - Street 1:5735 WESTMINSTER WAY
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7730
Practice Address - Country:US
Practice Address - Phone:517-575-0771
Practice Address - Fax:517-339-4035
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010009731041C0700X
MI4101000342106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP24720Medicare ID - Type Unspecified