Provider Demographics
NPI:1790858264
Name:PEASLEY, JAMES ARCHIE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ARCHIE
Last Name:PEASLEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 SNELLING AVE N
Mailing Address - Street 2:#104
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-7115
Mailing Address - Country:US
Mailing Address - Phone:612-382-5608
Mailing Address - Fax:651-633-5238
Practice Address - Street 1:2780 SNELLING AVE N
Practice Address - Street 2:#104
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-7115
Practice Address - Country:US
Practice Address - Phone:651-633-5290
Practice Address - Fax:651-633-5238
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist