Provider Demographics
NPI:1699813238
Name:GRYDER, PEGGY CHRISTINA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:CHRISTINA
Last Name:GRYDER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11914 ACORN CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1455
Mailing Address - Country:US
Mailing Address - Phone:512-585-2692
Mailing Address - Fax:512-249-7675
Practice Address - Street 1:11914 ACORN CREEK TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1455
Practice Address - Country:US
Practice Address - Phone:512-585-2692
Practice Address - Fax:512-249-7675
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional