Healthcare Provider Details

I. General information

NPI: 1457134702
Provider Name (Legal Business Name): MARITA ELAINE PEAK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 711
CRESTONE CO
81131-0711
US

IV. Provider business mailing address

8745 COUNTY ROAD 9 S
ALAMOSA CO
81101-9610
US

V. Phone/Fax

Practice location:
  • Phone: 719-496-6554
  • Fax:
Mailing address:
  • Phone: 719-589-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0024590
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: