Provider Demographics
NPI:1780730945
Name:PEAVEY, BARBARA S (PHD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:S
Last Name:PEAVEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W WALL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5276
Mailing Address - Country:US
Mailing Address - Phone:817-481-5657
Mailing Address - Fax:817-431-6002
Practice Address - Street 1:700 W WALL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5276
Practice Address - Country:US
Practice Address - Phone:817-481-5657
Practice Address - Fax:817-431-6002
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22787103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D20RMedicare ID - Type Unspecified