Individual
THOMAS PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2151 RIDGECREST RD SE APT 8, GRAND RAPIDS, MI 49546-4366
(502) 439-7039
Mailing address
2151 RIDGECREST RD SE APT 8, GRAND RAPIDS, MI 49546-4366
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
270750
KY
101YM0800X
Mental Health Counselor
Primary
6401224433
MI
Other
Enumeration date
12/03/2024
Last updated
12/03/2024
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