Healthcare Provider Details

I. General information

NPI: 1982925699
Provider Name (Legal Business Name): RICHARD TROY PEACE LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 BLUEGRASS DR
HIGHLAND HEIGHTS KY
41076-1577
US

IV. Provider business mailing address

81 MANIACAL WAY
GLENCOE KY
41046-1102
US

V. Phone/Fax

Practice location:
  • Phone: 859-442-8500
  • Fax: 859-442-8555
Mailing address:
  • Phone: 859-567-4430
  • Fax: 859-567-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1052
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number104568
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: