Provider Demographics
NPI:1972073682
Name:PECK, COURTNEY (LCSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 NW TREGATEN LN
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7101
Mailing Address - Country:US
Mailing Address - Phone:360-930-4497
Mailing Address - Fax:
Practice Address - Street 1:17791 FJORD DR NE STE 122
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8482
Practice Address - Country:US
Practice Address - Phone:360-930-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASWIA.SC.60856259101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor