MEDICARE: SCOTT CHARLES PEACOCK M.A.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	12382	TX
2	101YP2500X	Professional Counselor	71179	TX
3	106H00000X	Marriage & Family Therapist	202198	TX

General Provider Information

NPI Number	:	1467861575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT CHARLES PEACOCK M.A.

Provider Business Mailing Address
First Line	:	9914 WINCHESTER VILLAGE CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-3820
Country	:	US
Telephone Number	:	713-478-5650
Fax Number	:

Provider Business Practice Location Address
First Line	:	10330 LAKE RD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1696
Country	:	US
Telephone Number	:	713-478-5650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	08/04/2014

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Directions to “ SCOTT CHARLES PEACOCK M.A.” Practice Location

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