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General NPI Number Information
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NPI Number | 1518943133
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Entity Type | Individual
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Provider Name | PEGGY SMITH PUCKETT LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 2130 WILLIE GROCE RD
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City | GLASGOW
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State | KY
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Zip | 42141-7831
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Country | US
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Telephone | 270-791-2178
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Fax | 270-710-1794
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Provider Business Mailing Address
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Address Line | 2130 WILLIE GROCE RD
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City | GLASGOW
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State | KY
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Zip | 42141-7831
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Country | US
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Telephone | 270-791-2178
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Fax | 270-710-1794
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0615
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License Number State | KY
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