Provider Demographics
NPI:1518737790
Name:NEW PEAKS, LLC
Entity Type:Organization
Organization Name:NEW PEAKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ESTELLA
Authorized Official - Last Name:MANIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:321-961-2097
Mailing Address - Street 1:1940 CHESTER HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:TN
Mailing Address - Zip Code:37191-9281
Mailing Address - Country:US
Mailing Address - Phone:321-961-2097
Mailing Address - Fax:
Practice Address - Street 1:1940 CHESTER HARRIS RD
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:TN
Practice Address - Zip Code:37191-9281
Practice Address - Country:US
Practice Address - Phone:321-961-2097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)