Healthcare Provider Details

I. General information

NPI: 1558871384
Provider Name (Legal Business Name): AIMEE PEACE SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 GLENEAGLES BND
ZACHARY LA
70791-5447
US

IV. Provider business mailing address

1617 KENTUCKY ST
RACINE WI
53405-3213
US

V. Phone/Fax

Practice location:
  • Phone: 414-460-6130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: