Provider Demographics
NPI:1083303689
Name:PEETE, MISTY LYNN (LLC)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LYNN
Last Name:PEETE
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:MS
Other - First Name:MISTY
Other - Middle Name:LYNN
Other - Last Name:BRISCOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26810 COLGATE ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-3108
Mailing Address - Country:US
Mailing Address - Phone:734-968-0307
Mailing Address - Fax:
Practice Address - Street 1:26300 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2019
Practice Address - Country:US
Practice Address - Phone:734-968-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2024-11-07
Deactivation Date:2024-10-16
Deactivation Code:
Reactivation Date:2024-11-06
Provider Licenses
StateLicense IDTaxonomies
MI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health