Provider Demographics
NPI:1346384690
Name:PEACOCK, PATTI MAE (LPC)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:MAE
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11607 BIRCHBARK TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1927
Mailing Address - Country:US
Mailing Address - Phone:512-451-7337
Mailing Address - Fax:512-451-8729
Practice Address - Street 1:5425 BURNET RD # A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1627
Practice Address - Country:US
Practice Address - Phone:512-451-7337
Practice Address - Fax:512-451-8729
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19507101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional