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Organization
PEGGY LISS MSW, L.L.C.
Active
Organization
PEGGY LISS MSW, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PEGGY LISS MSW (CLINICAL SOCIAL WORKER)
(269) 598-3886
Entity
Organization
Contact information
Practice address
2311 GLENWOOD DR, KALAMAZOO, MI 49008-1978
(269) 598-3886
Mailing address
2311 GLENWOOD DR, KALAMAZOO, MI 49008-1978
(269) 598-3886
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285690685
—
MI
Enumeration date
06/18/2019
Last updated
06/18/2019
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