Healthcare Provider Details

I. General information

NPI: 1457978900
Provider Name (Legal Business Name): PEAK SERENITY COUNSELING & NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 BROADWAY STE 314C
BOULDER CO
80302-5233
US

IV. Provider business mailing address

808 S ARLINGTON MILL DR APT 204
ARLINGTON VA
22204-6019
US

V. Phone/Fax

Practice location:
  • Phone: 330-703-0435
  • Fax:
Mailing address:
  • Phone: 330-703-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: CRISTA L. STUDER
Title or Position: OWNER
Credential: MS, LPC, RDN, NCC
Phone: 330-703-0435