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General NPI Number Information
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NPI Number | 1528366903
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Entity Type | Organization
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Legal Business Name | PEAK MENTAL WELLNESS AND COUNSELING LLC
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 2805 BLAINE ST STE 120
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City | CALDWELL
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State | ID
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Zip | 83605-4599
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Country | US
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Telephone | 208-459-4412
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Fax | 208-454-7296
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Provider Business Mailing Address
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Address Line | 2805 BLAINE ST STE 120
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City | CALDWELL
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State | ID
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Zip | 83605-4599
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Country | US
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Telephone | 208-459-4412
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Fax | 208-454-7296
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL E WILEY
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Credential | LCSW
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Telephone | 208-724-9276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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