Provider Demographics
NPI:1356710701
Name:PEEPLES, OTIS
Entity type:Individual
Prefix:
First Name:OTIS
Middle Name:
Last Name:PEEPLES
Suffix:
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 1:201 N WESTSHORE DR APT 708
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7232
Mailing Address - Country:US
Mailing Address - Phone:847-493-3700
Mailing Address - Fax:847-493-3714
Practice Address - Street 1:134 N LASALLE SUITE 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604
Practice Address - Country:US
Practice Address - Phone:847-493-3700
Practice Address - Fax:847-493-3714
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008189101YA0400X
IL26792101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)