Provider Demographics
NPI:1801175245
Name:PEEBLES, EZEKIEL (LPC)
Entity type:Individual
Prefix:MR
First Name:EZEKIEL
Middle Name:
Last Name:PEEBLES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 GRANVILLE ST
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2967
Mailing Address - Country:US
Mailing Address - Phone:614-478-3050
Mailing Address - Fax:614-428-0567
Practice Address - Street 1:181 GRANVILLE ST
Practice Address - Street 2:SUITE 200B
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2967
Practice Address - Country:US
Practice Address - Phone:614-478-3050
Practice Address - Fax:614-428-0567
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0900173101YM0800X
OHC.0900173101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor