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General NPI Number Information
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NPI Number | 1811338148
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Entity Type | Organization
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Legal Business Name | PEAK RECOVERY LLC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 2423 S GEORGIA AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4477
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Country | US
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Telephone | 208-455-1788
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Fax | 208-455-2044
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Provider Business Mailing Address
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Address Line | 2423 S GEORGIA AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4477
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Country | US
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Telephone | 208-455-1788
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Fax | 208-455-2044
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Authorized Official
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Title or Position | OWNER
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Name | MICHONNE LEE PIEKMSA
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Credential | MS, , LPC ACADC
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Telephone | 208-455-1788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | LPC-5173
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 151
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License Number State | ID
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