Provider Demographics
NPI:1831460237
Name:PEGGY COURTLAND, MA, LPC, LCDC, PLLC
Entity Type:Organization
Organization Name:PEGGY COURTLAND, MA, LPC, LCDC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COURTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LCDC
Authorized Official - Phone:830-613-1214
Mailing Address - Street 1:PO BOX 1831
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639-1831
Mailing Address - Country:US
Mailing Address - Phone:830-613-1214
Mailing Address - Fax:325-388-2460
Practice Address - Street 1:100 BUNNY RUN LN
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657-6188
Practice Address - Country:US
Practice Address - Phone:830-613-1214
Practice Address - Fax:325-388-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
TX65096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty