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NPI Code Detail

MEDICARE: SHAMEEN PEACOCK M.ED., LPC

MEDICARE: SHAMEEN PEACOCK M.ED., 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1861077588
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAMEEN PEACOCK M.ED., LPC
Provider Business Mailing Address
First Line : 4780 I 55 N STE 105
Second Line :
City : JACKSON
State : MS
Zip : 39211-5542
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4780 I 55 N STE 105
Second Line :
City : JACKSON
State : MS
Zip : 39211-5542
Country : US
Telephone Number : 601-956-4816
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2021
Last Update Date : 03/30/2026

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Directions to “ SHAMEEN PEACOCK M.ED., LPC” Practice Location

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