Provider Demographics
NPI:1205039286
Name:PEACH, SUSAN C (MS, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:PEACH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7661 MCLAUGHLIN RD
Mailing Address - Street 2:#524
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4727
Mailing Address - Country:US
Mailing Address - Phone:719-247-9751
Mailing Address - Fax:888-782-5643
Practice Address - Street 1:7661 MCLAUGHLIN RD
Practice Address - Street 2:#524
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4727
Practice Address - Country:US
Practice Address - Phone:719-247-9751
Practice Address - Fax:888-782-5643
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional