Provider Demographics
NPI:1679000624
Name:PEEBLES, CARMEN
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:PEEBLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 MERCANTILE ST UNIT 1215
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3973
Mailing Address - Country:US
Mailing Address - Phone:720-491-8171
Mailing Address - Fax:720-362-0043
Practice Address - Street 1:2355 MERCANTILE ST UNIT 1215
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3973
Practice Address - Country:US
Practice Address - Phone:720-491-8171
Practice Address - Fax:720-362-0043
Is Sole Proprietor?:No
Enumeration Date:2017-05-20
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-22-62836103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician