Pediatric Counseling Center, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801081725 Issued in MI

Legal business name

PEDIATRIC COUNSELING CENTER, LLC

Practice address

950 N 10TH St
Suite 200
Kalamazoo, MI 49009-6112

Phone

(269) 372-6500

Fax

(269) 372-6503

NPI assigned

Jun 30, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jodi Ten Broeke

Title

Owner

Phone

(269) 372-6500

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1154583235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N 10TH ST",
            "address_2": "SUITE 200",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490096112",
            "telephone_number": "269-372-6500",
            "fax_number": "269-372-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 N 10TH ST",
            "address_2": "SUITE 200",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490096112",
            "telephone_number": "269-372-6500",
            "fax_number": "269-372-6503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "TEN BROEKE",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-372-6500",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801081725",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristy Pearson
• Roberta Pearson, RPH
• Dustin Daniel Peck, LMSW
• Stephen L Peck, M.D.
• Lukas Lee Pederson, LPC
• Sierra Pedraja
• Brycen Wade Peebles
• Andrew Peekstok
• Peggy Liss MSW, L.L.C.
• Michael James Peikert, M.D.

• Clinical Social Worker in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.