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NPI Code Detail

MEDICARE: LAUREN PEACOCK MA, LPC

MEDICARE: LAUREN PEACOCK MA, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor71423TX

General Provider Information

NPI Number : 1669088134
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN PEACOCK MA, LPC
Provider Business Mailing Address
First Line : 4124 CHAPEL RDG
Second Line :
City : TYLER
State : TX
Zip : 75707-5403
Country : US
Telephone Number : 903-714-7205
Fax Number :
Provider Business Practice Location Address
First Line : 17121 HIGHWAY 69 S
Second Line :
City : TYLER
State : TX
Zip : 75703-8091
Country : US
Telephone Number : 903-714-7205
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2020
Last Update Date : 09/21/2020

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Directions to “ LAUREN PEACOCK MA, LPC” Practice Location

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