Healthcare Provider Details

I. General information

NPI: 1831308980
Provider Name (Legal Business Name): MOE PECK PH.D,ATR,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5617 ADAMS AVE
AUSTIN TX
78756-1102
US

IV. Provider business mailing address

PO BOX 33006
AUSTIN TX
78764-0006
US

V. Phone/Fax

Practice location:
  • Phone: 512-517-5860
  • Fax:
Mailing address:
  • Phone: 512-517-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13022
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number1602
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: