Healthcare Provider Details

I. General information

NPI: 1538788740
Provider Name (Legal Business Name): ERIN PEACE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8956 RESEARCH BLVD BLDG 2
AUSTIN TX
78758-5969
US

IV. Provider business mailing address

8956 RESEARCH BLVD BLDG 2
AUSTIN TX
78758-5969
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-7337
  • Fax: 512-451-8729
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number64341
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number64341
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: