Provider Demographics
NPI:1578279105
Name:PECKHAM, STEPHANIE (LAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PECKHAM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 N SCOTTSDALE RD STE D120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3506
Mailing Address - Country:US
Mailing Address - Phone:480-660-8757
Mailing Address - Fax:
Practice Address - Street 1:7373 N SCOTTSDALE RD STE D120
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-3506
Practice Address - Country:US
Practice Address - Phone:480-660-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20142101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor