Provider Demographics
NPI:1932610920
Name:PEAK LAC COUNSELING LLC
Entity Type:Organization
Organization Name:PEAK LAC COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:406-827-1957
Mailing Address - Street 1:391 BIG BEAVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TROUT CREEK
Mailing Address - State:MT
Mailing Address - Zip Code:59874-9631
Mailing Address - Country:US
Mailing Address - Phone:406-827-1957
Mailing Address - Fax:
Practice Address - Street 1:391 BIG BEAVER CREEK RD
Practice Address - Street 2:
Practice Address - City:TROUT CREEK
Practice Address - State:MT
Practice Address - Zip Code:59874-9631
Practice Address - Country:US
Practice Address - Phone:406-827-1957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1419101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty