Provider Demographics
NPI:1598230369
Name:PEELE, THEODORE OWEN
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:OWEN
Last Name:PEELE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:HYDABURG
Mailing Address - State:AK
Mailing Address - Zip Code:99922-0069
Mailing Address - Country:US
Mailing Address - Phone:907-285-3462
Mailing Address - Fax:907-285-3464
Practice Address - Street 1:8TH STREET EXT
Practice Address - Street 2:
Practice Address - City:HYDABURG
Practice Address - State:AK
Practice Address - Zip Code:99922-0069
Practice Address - Country:US
Practice Address - Phone:907-285-3462
Practice Address - Fax:907-285-3464
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health