Provider Demographics
NPI:1003117151
Name:PEACH, SHERRI R (MA)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:R
Last Name:PEACH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LAKEWOOD CIR
Mailing Address - Street 2:STE. 110H
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-2617
Mailing Address - Country:US
Mailing Address - Phone:719-597-6457
Mailing Address - Fax:
Practice Address - Street 1:411 LAKEWOOD CIR
Practice Address - Street 2:STE. 110H
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-2617
Practice Address - Country:US
Practice Address - Phone:719-597-6457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist