Healthcare Provider Details

I. General information

NPI: 1386981025
Provider Name (Legal Business Name): PEGGY WUNDERLICH L P C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PEGGY PIPKIN LPC

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15015 MARLEBONE CT
HOUSTON TX
77069-2021
US

IV. Provider business mailing address

15015 MARLEBONE CT
HOUSTON TX
77069-2021
US

V. Phone/Fax

Practice location:
  • Phone: 832-859-2417
  • Fax:
Mailing address:
  • Phone: 832-859-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number09720
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: