Provider Demographics
NPI:1124755053
Name:BRITTANY PETEREK, LLC
Entity type:Organization
Organization Name:BRITTANY PETEREK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETEREK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-344-1490
Mailing Address - Street 1:501 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4170
Mailing Address - Country:US
Mailing Address - Phone:616-344-1490
Mailing Address - Fax:
Practice Address - Street 1:426 CENTURY LN STE 100
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2200
Practice Address - Country:US
Practice Address - Phone:616-344-1490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health