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General NPI Number Information
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NPI Number | 1912060286
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Entity Type | Individual
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Provider Name | ROBERT C PEACH LPCC
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 2115 LEITER RD
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City | MIAMISBURG
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State | OH
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Zip | 45342-3659
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Country | US
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Telephone | 937-384-6901
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Fax | 937-522-7978
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Provider Business Mailing Address
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Address Line | 2110 LEITER RD
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City | MIAMISBURG
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State | OH
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Zip | 45342-3660
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Country | US
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Telephone | 937-914-7067
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Fax | 937-522-7513
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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 | 0001647
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License Number State | OH
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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 | F0000125
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | E0001647
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | F125
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License Number State | OH
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