Provider Demographics
NPI:1043083058
Name:PEAK NEUROFEEDBACK LLC
Entity Type:Organization
Organization Name:PEAK NEUROFEEDBACK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CATE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:802-999-6634
Mailing Address - Street 1:20 W CANAL ST STE C11
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2147
Mailing Address - Country:US
Mailing Address - Phone:802-662-0208
Mailing Address - Fax:
Practice Address - Street 1:20 W CANAL ST STE C11
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-2147
Practice Address - Country:US
Practice Address - Phone:802-662-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty