Provider Demographics
NPI:1699939785
Name:PEEL, STEPHANIE B (LLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:B
Last Name:PEEL
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9769 VERGENNES ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-9644
Mailing Address - Country:US
Mailing Address - Phone:616-821-3742
Mailing Address - Fax:
Practice Address - Street 1:9769 VERGENNES ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9644
Practice Address - Country:US
Practice Address - Phone:616-821-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013218103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling