Provider Demographics
NPI:1205037157
Name:PECK, KATHERINE PECK LOUISE (RN, CNS, PNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE PECK
Middle Name:LOUISE
Last Name:PECK
Suffix:
Gender:F
Credentials:RN, CNS, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11904 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8331
Mailing Address - Country:US
Mailing Address - Phone:505-521-3911
Mailing Address - Fax:505-646-2167
Practice Address - Street 1:1850 COPPER LOOP
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-8139
Practice Address - Country:US
Practice Address - Phone:505-647-7642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR48558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health