Provider Demographics
NPI:1083117998
Name:PEAK WELLNESS COUNSELING SERVICE, LLC
Entity Type:Organization
Organization Name:PEAK WELLNESS COUNSELING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMUTKA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-375-4516
Mailing Address - Street 1:2210 E. LA SALLE STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-375-4516
Mailing Address - Fax:415-795-4316
Practice Address - Street 1:2210 E. LA SALLE STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-375-4516
Practice Address - Fax:415-795-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty