Provider Demographics
NPI:1740509439
Name:PEEPLES, KIM M (LPC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:M
Last Name:PEEPLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:M
Other - Last Name:JUENGLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:510 W. 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001
Mailing Address - Country:US
Mailing Address - Phone:307-632-9362
Mailing Address - Fax:
Practice Address - Street 1:510 W. 29TH STREET
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-632-9362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20168101YP2500X
WYLPC-1816101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
14033471OtherCAQH PROVIDER ID