Provider Demographics
NPI:1619755170
Name:PEER SUPPORT & WELLNESS LLC
Entity Type:Organization
Organization Name:PEER SUPPORT & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEER SUPPORT SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ARIANA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:PSP
Authorized Official - Phone:626-542-1625
Mailing Address - Street 1:1665 HOOKER ST APT 16
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1974
Mailing Address - Country:US
Mailing Address - Phone:626-542-1625
Mailing Address - Fax:
Practice Address - Street 1:1665 HOOKER ST APT 16
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1974
Practice Address - Country:US
Practice Address - Phone:626-542-1625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty