Provider Demographics
NPI:1831349810
Name:PEISCH, DOUGLAS J
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:PEISCH
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 1:3547 CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2422
Mailing Address - Country:US
Mailing Address - Phone:707-226-6245
Mailing Address - Fax:707-226-6195
Practice Address - Street 1:1320 2ND ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2941
Practice Address - Country:US
Practice Address - Phone:707-226-6245
Practice Address - Fax:707-226-6195
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health