=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811009574
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS A PEICHEL MA LICSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7064 W PT DOUGLAS RD STE #201
-----------------------------------------------------
City | COTTAGE GROVE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-458-5224
-----------------------------------------------------
Fax | 651-458-5310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 W PINE ST
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-439-8800
-----------------------------------------------------
Fax | 651-439-1040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW07209
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT0189
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------