Healthcare Provider Details

I. General information

NPI: 1184371809
Provider Name (Legal Business Name): PEACE LILY THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3144 N RIDGEWAY AVE APT 2
CHICAGO IL
60618-6616
US

IV. Provider business mailing address

3144 N RIDGEWAY AVE APT 2
CHICAGO IL
60618-6616
US

V. Phone/Fax

Practice location:
  • Phone: 828-337-3223
  • Fax:
Mailing address:
  • Phone: 828-337-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: LILY PEIFER
Title or Position: THERAPIST
Credential: LCSW
Phone: 828-337-3223