Healthcare Provider Details

I. General information

NPI: 1427627819
Provider Name (Legal Business Name): PEAK POTENTIAL BEHAVIOR & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 CITADEL DR E STE 345
COLORADO SPRINGS CO
80909-5326
US

IV. Provider business mailing address

685 CITADEL DR E STE 345
COLORADO SPRINGS CO
80909-5326
US

V. Phone/Fax

Practice location:
  • Phone: 940-613-2618
  • Fax:
Mailing address:
  • Phone: 940-613-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STACEY WILSON
Title or Position: OWNER/ CLINICAL DIRECTOR
Credential:
Phone: 940-368-7105