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NPI Code Detail

MEDICARE: LANCE PEACOR

MEDICARE: LANCE PEACOR
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1427582733
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANCE PEACOR
Provider Business Mailing Address
First Line : 2848 GRASSLANDS DR APT 1914
Second Line :
City : SACRAMENTO
State : CA
Zip : 95833-3531
Country : US
Telephone Number : 916-730-0612
Fax Number : 916-441-0286
Provider Business Practice Location Address
First Line : 3780 ROSIN CT STE 110
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-1698
Country : US
Telephone Number : 916-441-0226
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2017
Last Update Date : 03/06/2018

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Directions to “ LANCE PEACOR ” Practice Location

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