Provider Demographics
NPI:1780203406
Name:PEEBLES, ERIC MINTON
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MINTON
Last Name:PEEBLES
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 1:1919 OXMOOR RD # 272
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3502
Mailing Address - Country:US
Mailing Address - Phone:888-678-2767
Mailing Address - Fax:888-678-2767
Practice Address - Street 1:0N 163 WINDERMERE RD.
Practice Address - Street 2:UNIT 1102
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-6019
Practice Address - Country:US
Practice Address - Phone:888-678-2767
Practice Address - Fax:888-678-2767
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDCATEMP-005638101YP2500X
IL178.015850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional