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General NPI Number Information
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NPI Number | 1043083058
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Entity Type | Organization
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Legal Business Name | PEAK NEUROFEEDBACK LLC
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 20 W CANAL ST STE C11
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City | WINOOSKI
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State | VT
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Zip | 05404-2147
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Country | US
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Telephone | 802-662-0208
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Fax |
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Provider Business Mailing Address
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Address Line | 20 W CANAL ST STE C11
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City | WINOOSKI
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State | VT
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Zip | 05404-2147
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Country | US
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Telephone | 802-662-0208
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATIE CATE
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Credential | MA
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Telephone | 802-999-6634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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