Provider Demographics
NPI:1811009574
Name:PEICHEL, THOMAS A (MA LICSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:PEICHEL
Suffix:
Gender:M
Credentials:MA LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082
Mailing Address - Country:US
Mailing Address - Phone:651-439-8800
Mailing Address - Fax:651-439-1040
Practice Address - Street 1:7064 W PT DOUGLAS RD
Practice Address - Street 2:STE #201
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016
Practice Address - Country:US
Practice Address - Phone:651-458-5224
Practice Address - Fax:651-458-5310
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLCSW072091041C0700X
MNLMFT0189106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA8655040OtherBCBS
MNHP38609OtherHEALTH PARTNERS
MN130P35PEOtherBCBS