Provider Demographics
NPI:1255788972
Name:PEACH, WILLIAM III
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:PEACH
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-1635
Mailing Address - Country:US
Mailing Address - Phone:800-531-4236
Mailing Address - Fax:319-483-6661
Practice Address - Street 1:605 5TH ST
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-1635
Practice Address - Country:US
Practice Address - Phone:800-531-4236
Practice Address - Fax:319-483-6661
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079765101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health