Provider Demographics
NPI:1891573713
Name:PETER DESMANGLES COUNSELING LLC
Entity Type:Organization
Organization Name:PETER DESMANGLES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMANGLES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LCAC
Authorized Official - Phone:765-586-8155
Mailing Address - Street 1:25 EXECUTIVE DR STE G
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4880
Mailing Address - Country:US
Mailing Address - Phone:765-337-7757
Mailing Address - Fax:
Practice Address - Street 1:25 EXECUTIVE DR STE G
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4880
Practice Address - Country:US
Practice Address - Phone:765-337-7757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)