MEDICARE: PEAK PSYCHOLOGICAL SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1346711900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	9076 KENNEBEC PASS TRL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7017
Country	:	US
Telephone Number	:	719-623-2356
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 E WOODMEN RD STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3591
Country	:	US
Telephone Number	:	719-623-2356
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICOLE PEAK
Credential	:	PHD
Telephone Number	:	719-623-2356

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	10/26/2020

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