MEDICARE: MR. WILLIAM M PEEBLES 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
1	101YP2500X	Professional Counselor	2465	CO

General Provider Information

NPI Number	:	1982750220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM M PEEBLES LPC

Provider Business Mailing Address
First Line	:	2669 S JACKSON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-5640
Country	:	US
Telephone Number	:	303-757-3402
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 GAYLORD ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1207
Country	:	US
Telephone Number	:	303-921-8122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	07/08/2007

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