Provider Demographics
NPI:1225683105
Name:PECKHAM, TRENA (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:TRENA
Middle Name:
Last Name:PECKHAM
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13386 NEWBY PLANTATION LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-8373
Mailing Address - Country:US
Mailing Address - Phone:920-242-1772
Mailing Address - Fax:
Practice Address - Street 1:116 LILY FLAGG RD SW STE D
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3066
Practice Address - Country:US
Practice Address - Phone:256-881-5352
Practice Address - Fax:256-881-5355
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7411101YP2500X
ALL506106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional