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General NPI Number Information
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NPI Number | 1598946147
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Entity Type | Individual
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Provider Name | EDWARD PECK LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/23/2007
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Last Update Date | 06/22/2025
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Provider Practice Location Address
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Address Line | 4001 W END RD STE 3
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City | ARCATA
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State | CA
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Zip | 95521-9628
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Country | US
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Telephone | 707-502-2905
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 965
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City | ARCATA
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State | CA
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Zip | 95518-0965
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Country | US
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Telephone | 707-826-3236
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 67178
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License Number State | CA
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