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General NPI Number Information
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NPI Number | 1225683105
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Entity Type | Individual
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Provider Name | TRENA PECKHAM LMFT, LPC
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Gender | Female
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 116 LILY FLAGG RD SW STE D
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City | HUNTSVILLE
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State | AL
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Zip | 35802-3066
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Country | US
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Telephone | 256-881-5352
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Fax | 256-881-5355
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Provider Business Mailing Address
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Address Line | 13386 NEWBY PLANTATION LN
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City | ATHENS
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State | AL
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Zip | 35613-8373
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Country | US
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Telephone | 920-242-1772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-7411
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | L506
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License Number State | AL
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