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General NPI Number Information
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NPI Number | 1831012509
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Entity Type | Individual
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Provider Name | BREANNA PEACOCK
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Gender | Female
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 18635 I-10
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City | VIDOR
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State | TX
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Zip | 77662
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Country | US
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Telephone | 409-238-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 1950 DRISKILL ST
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City | BEAUMONT
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State | TX
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Zip | 77706-3009
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 114213
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License Number State | TX
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