Healthcare Provider Details

I. General information

NPI: 1801827357
Provider Name (Legal Business Name): BEN W PEEPLES MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SIDNEY & LAMONT STREETS 116C
MOUNTAIN HOME TN
37684-4000
US

IV. Provider business mailing address

PO BOX 4000 116C
MOUNTAIN HOME TN
37684-4000
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax: 423-979-3447
Mailing address:
  • Phone: 423-926-1171
  • Fax: 423-979-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLDC0000000450
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: