Active NPI
Tyrone Peterson
- Clinical Social Worker
- Highland, MI
National Provider Identifier
1972234821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6851114765
- Practice address
- 210 W Highland Rd Ste 102
Highland, MI 48357-4573 - Phone
- (248) 529-3167
- Fax
- (810) 215-1135
- NPI assigned
- Jun 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6851114765 | MI | Primary |
Addresses
Primary practice location
210 W Highland Rd Ste 102
Highland, MI 48357-4573
Mailing address
210 W Highland Rd Ste 102
Highland, MI 48357-4573
Phone (248) 529-3167
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6851114765 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655769600000",
"number": "1972234821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 W HIGHLAND RD STE 102",
"city": "HIGHLAND",
"state": "MI",
"postal_code": "483574573",
"telephone_number": "248-529-3167",
"fax_number": "810-215-1135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 W HIGHLAND RD STE 102",
"city": "HIGHLAND",
"state": "MI",
"postal_code": "483574573",
"telephone_number": "248-529-3167",
"fax_number": "810-215-1135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "TYRONE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-21",
"last_updated": "2022-06-21",
"certification_date": "2022-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6851114765",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Highland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.