Doctor Name: | ALECIA MARIE PERREAULT |
NPI Number: | 1417394123 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LLPC |
License Number: | 6401013414 |
Business Practice Address: | 1199 Harris Ave Tawas City, MI - 487639681 |
Business Phone Number: | 9893628636 |
Business Fax Number: | 9893627800 |
Mailing Address: | Po Box 310, TAWAS CITY |
State: | MI |
Postal Code: | 487640310 |
Phone Number: | 9893628636 |
Fax Number: | 9893627800 |
NPI Enumeration Date: | 06/04/2013 |
NPI Last Update Date: | 08/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 6401013414 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |