Provider Demographics
NPI:1629742713
Name:PEARTREE PROFESSIONAL COUNSELING, LLC
Entity Type:Organization
Organization Name:PEARTREE PROFESSIONAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:765-273-8569
Mailing Address - Street 1:4132 W WOODS EDGE LN
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-6082
Mailing Address - Country:US
Mailing Address - Phone:765-716-7663
Mailing Address - Fax:
Practice Address - Street 1:1945 W ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2265
Practice Address - Country:US
Practice Address - Phone:765-273-8569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300059100Medicaid