Provider Demographics
NPI:1790143154
Name:PEACOCK, ALYSSA CAROLINE
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CAROLINE
Last Name:PEACOCK
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 1:4293 CUTTING HORSE CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-2998
Mailing Address - Country:US
Mailing Address - Phone:775-772-3272
Mailing Address - Fax:
Practice Address - Street 1:415 US HIGHWAY 95A S
Practice Address - Street 2:SUITE G702
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-9261
Practice Address - Country:US
Practice Address - Phone:775-575-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health