Provider Demographics
NPI:1831308980
Name:PECK, MOE (PHD,ATR,LPC)
Entity Type:Individual
Prefix:DR
First Name:MOE
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:PHD,ATR,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33006
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78764-0006
Mailing Address - Country:US
Mailing Address - Phone:512-517-5860
Mailing Address - Fax:
Practice Address - Street 1:5617 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1102
Practice Address - Country:US
Practice Address - Phone:512-517-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13022101YP2500X
NM1602221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107-19287OtherPHCS