Provider Demographics
NPI:1780976159
Name:PEACOCK, WILLIAM WALKER (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALKER
Last Name:PEACOCK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 WEST LOOP S
Mailing Address - Street 2:SUITE 215
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-9084
Mailing Address - Country:US
Mailing Address - Phone:713-621-9515
Mailing Address - Fax:713-621-7015
Practice Address - Street 1:1001 WEST LOOP S
Practice Address - Street 2:SUITE 215
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-9084
Practice Address - Country:US
Practice Address - Phone:713-621-9515
Practice Address - Fax:713-621-7015
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical