Healthcare Provider Details

I. General information

NPI: 1659912988
Provider Name (Legal Business Name): PEAK MENTAL HEALTH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SKOKIE BLVD STE 207
NORTHBROOK IL
60062-2818
US

IV. Provider business mailing address

654 KINCAID ST
HIGHLAND PARK IL
60035-5038
US

V. Phone/Fax

Practice location:
  • Phone: 812-320-3616
  • Fax:
Mailing address:
  • Phone: 812-320-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE ASZODI DUCHIN
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 812-320-3616