Provider Demographics
NPI:1467827212
Name:EPPOLITO, PEG JEAN (LMHC, CADC)
Entity Type:Individual
Prefix:MRS
First Name:PEG
Middle Name:JEAN
Last Name:EPPOLITO
Suffix:
Gender:F
Credentials:LMHC, CADC
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:JEAN
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, CADC
Mailing Address - Street 1:800 5TH ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1317
Mailing Address - Country:US
Mailing Address - Phone:712-234-2300
Mailing Address - Fax:712-234-2398
Practice Address - Street 1:3320 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-3200
Practice Address - Country:US
Practice Address - Phone:712-202-0777
Practice Address - Fax:712-202-0780
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05204101YA0400X
IA001693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)