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General NPI Number Information
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NPI Number | 1306383435
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Entity Type | Individual
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Provider Name | CRISTINA PECK MA
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Gender | Female
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 12741 RESEARCH BLVD STE 303
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City | AUSTIN
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State | TX
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Zip | 78759-4329
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Country | US
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Telephone | 512-632-9194
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Fax |
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Provider Business Mailing Address
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Address Line | 2704 BENEVENTO WAY
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City | CEDAR PARK
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State | TX
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Zip | 78613-4306
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Country | US
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Telephone | 512-257-2704
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 71697
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 202103
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 202103
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 71697
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License Number State | TX
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