Provider Demographics
NPI:1225801566
Name:MCPEAK, PAMELA S (LPCC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:MCPEAK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 MCPEAK RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN RUN
Mailing Address - State:KY
Mailing Address - Zip Code:42133-8731
Mailing Address - Country:US
Mailing Address - Phone:615-995-8455
Mailing Address - Fax:
Practice Address - Street 1:247 MCPEAK RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN RUN
Practice Address - State:KY
Practice Address - Zip Code:42133-8731
Practice Address - Country:US
Practice Address - Phone:615-995-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health