Provider Demographics
NPI:1356407886
Name:HEALEY, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:HEALEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 MARY COURT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1415
Mailing Address - Country:US
Mailing Address - Phone:810-240-0143
Mailing Address - Fax:
Practice Address - Street 1:1122 NORTH LEROY
Practice Address - Street 2:SUITE A
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1415
Practice Address - Country:US
Practice Address - Phone:810-240-0143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010803091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical