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General NPI Number Information
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NPI Number | 1053896415
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Entity Type | Organization
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Legal Business Name | PEAK THERAPEUTIC INC
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 6760 CORPORATE DR STE 140
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-5910
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Country | US
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Telephone | 951-837-3722
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Fax | 719-631-0720
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Provider Business Mailing Address
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Address Line | 6760 CORPORATE DR STE 140
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-5910
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Country | US
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Telephone | 951-837-3722
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Fax | 719-631-0720
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN RICHARD BOGSTAD
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Credential |
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Telephone | 951-837-3722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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