Provider Demographics
NPI:1083072987
Name:PEAT, ANDREKA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREKA
Middle Name:
Last Name:PEAT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 MACAO PLACE
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075
Mailing Address - Country:US
Mailing Address - Phone:678-570-2077
Mailing Address - Fax:
Practice Address - Street 1:6751 VIRGINIA PKWY # 200
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5515
Practice Address - Country:US
Practice Address - Phone:678-570-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX365000103T00000X, 103TC1900X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy