Healthcare Provider Details

I. General information

NPI: 1255788972
Provider Name (Legal Business Name): WILLIAM PEACH III LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 KIMBALL AVE STE 9
WATERLOO IA
50702-5732
US

IV. Provider business mailing address

3606 KIMBALL AVE STE 9
WATERLOO IA
50702-5732
US

V. Phone/Fax

Practice location:
  • Phone: 319-939-4599
  • Fax:
Mailing address:
  • Phone: 319-939-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number079765
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: