Provider Demographics
NPI:1568052876
Name:MCPEAK, KRISTY (LPC INTERN, NCC)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:MCPEAK
Suffix:
Gender:F
Credentials:LPC INTERN, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-2626
Mailing Address - Country:US
Mailing Address - Phone:541-536-4471
Mailing Address - Fax:
Practice Address - Street 1:139 SW 3RD ST # OR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4713
Practice Address - Country:US
Practice Address - Phone:541-286-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional