Healthcare Provider Details

I. General information

NPI: 1114863453
Provider Name (Legal Business Name): SCOTT PECKLER CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 GRAND AVE UNIT C
GRAND JUNCTION CO
81501-4623
US

IV. Provider business mailing address

844 GRAND AVE UNIT C
GRAND JUNCTION CO
81501-4623
US

V. Phone/Fax

Practice location:
  • Phone: 970-238-9801
  • Fax:
Mailing address:
  • Phone: 970-238-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0021289
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: