Destiny Peterson, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301016731 Issued in MI

Practice address

25900 Greenfield Rd Ste 100
Oak Park, MI 48237-1297

Phone

(248) 788-4300

NPI assigned

Dec 5, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Life Skills Village PLLCGroup PAC ID 2860624103, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Life Skills Village, PLLC

  • Community/Behavioral Health Agency
  • Oak Park, MI
  • NPI 1629316815
  Medicare reassignment Care Compare group
• Summit Psychiatric Services, P.L.C.

  • Specialist
  • Livonia, MI
  • NPI 1821042789
  Medicare reassignment NPD
• Back to You Rehab PLLC

  • Physical Therapist
  • Royal Oak, MI
  • NPI 1386124378
  NPD (past)

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

{
    "created_epoch": "1480896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1154865590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-486-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25900 GREENFIELD RD STE 100",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482371297",
            "telephone_number": "248-788-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DESTINY",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301016731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Perfecting Home Care
• Perfecting Home M-Care LLC
• Perry Drug Stores Inc and Subsidiaries
• Tyireshia Michelle Perry
• Personal Rehab Services P.C.
• Paul M Petre, M.D.
• Eman Petros, GENERAL DENTIST
• Phoenix Medical Associates
• Phoenix Medical Associates LLC
• Physical Medicine& Rehabilitation Consultant and Pain Management,P.C.

• Psychologist in Oak Park, MI
• Providers in Oak Park, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.