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General NPI Number Information
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NPI Number | 1780203406
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Entity Type | Individual
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Provider Name | DR. ERIC MINTON PEEBLES
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Gender | Male
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 0N 163 WINDERMERE RD. UNIT 1102
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City | WINFIELD
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State | IL
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Zip | 60190-6019
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Country | US
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Telephone | 888-678-2767
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Fax | 888-678-2767
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Provider Business Mailing Address
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Address Line | 1919 OXMOOR RD # 272
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City | BIRMINGHAM
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State | AL
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Zip | 35209-3502
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Country | US
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Telephone | 888-678-2767
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Fax | 888-678-2767
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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 | NJDCATEMP-005638
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.015850
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License Number State | IL
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