Doctor Name: | MR. WILLIAM PEACH |
NPI Number: | 1255788972 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 079765 |
Business Practice Address: | 605 5th St Grundy Center, IA - 506381635 |
Business Phone Number: | 8005314236 |
Business Fax Number: | 3194836661 |
Mailing Address: | 605 5th St, GRUNDY CENTER |
State: | IA |
Postal Code: | 506381635 |
Phone Number: | 8005314236 |
Fax Number: | 3194836661 |
NPI Enumeration Date: | 05/23/2016 |
NPI Last Update Date: | 05/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 079765 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |