Provider Demographics
NPI:1215774898
Name:PETER DEHAAN COUNSELING, LLC
Entity type:Organization
Organization Name:PETER DEHAAN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHAAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:616-822-8592
Mailing Address - Street 1:2846 RIVERWOODS DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9293
Mailing Address - Country:US
Mailing Address - Phone:616-822-8592
Mailing Address - Fax:
Practice Address - Street 1:2846 RIVERWOODS DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9293
Practice Address - Country:US
Practice Address - Phone:616-822-8592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty