Healthcare Provider Details

I. General information

NPI: 1003163429
Provider Name (Legal Business Name): PEAK INTERVENTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 N ARCADIA ST
COLORADO SPRINGS CO
80903-2639
US

IV. Provider business mailing address

1118 N ARCADIA ST
COLORADO SPRINGS CO
80903-2639
US

V. Phone/Fax

Practice location:
  • Phone: 720-384-5312
  • Fax:
Mailing address:
  • Phone: 720-384-5312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-8937
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number37593
License Number StateCO

VIII. Authorized Official

Name: MRS. HEATHER A ENOS
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: ED.S, BCBA
Phone: 720-384-5312