Provider Demographics
NPI:1508952342
Name:PECK, DANIEL (MED,SAC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:PECK
Suffix:
Gender:M
Credentials:MED,SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 S HOPE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2941
Mailing Address - Country:US
Mailing Address - Phone:213-747-2533
Mailing Address - Fax:
Practice Address - Street 1:4416 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1802
Practice Address - Country:US
Practice Address - Phone:323-668-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACADDTP#1210101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)