Provider Demographics
NPI:1174868087
Name:PEACEWAY COUNSELING LLC
Entity Type:Organization
Organization Name:PEACEWAY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:DANAE
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-592-6795
Mailing Address - Street 1:1627 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265
Mailing Address - Country:US
Mailing Address - Phone:812-592-6795
Mailing Address - Fax:866-317-2845
Practice Address - Street 1:1627 N STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-7479
Practice Address - Country:US
Practice Address - Phone:812-592-6795
Practice Address - Fax:866-317-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004749A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health