Bryan Peterson, MA, LLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6361007552 Issued in MI

Practice address

1098 Ann Arbor Rd W # 2491
Plymouth, MI 48170-2129

Phone

(248) 560-7561

NPI assigned

Aug 24, 2017

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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.

• Eryn Lasgalen Therapy LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Plymouth, MI
  • NPI 1689385478
  NPD Authorized official

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

{
    "created_epoch": "1503532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1649797259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1098 ANN ARBOR RD W # 2491",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481702129",
            "telephone_number": "248-560-7561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1098 ANN ARBOR RD W # 2491",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481702129",
            "telephone_number": "248-560-7561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BRYAN",
        "credential": "MA, LLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-24",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6361007552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Peshinski
• Jacob Peslar
• Anwyn Petek
• Brenda Peters, L.M.T.
• Whitney Peters
• Candace Peterson, MS, OTRL
• Fawne Peterson, MT
• Stacy Peterson
• Casey Petri
• Dhaval Petrolwala

• Clinical Psychologist in Plymouth, MI
• Providers in Plymouth, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.