MEDICARE: MARCELLA PEACH

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1710705082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELLA PEACH

Provider Business Mailing Address
First Line	:	4980 NW 41ST LN APT 5205
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-4601
Country	:	US
Telephone Number	:	770-363-6050
Fax Number	:

Provider Business Practice Location Address
First Line	:	4980 NW 41ST LN APT 5205
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-4601
Country	:	US
Telephone Number	:	770-363-6050
Fax Number	:

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

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	09/26/2024

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Directions to “ MARCELLA PEACH ” Practice Location

Language	Start Address	Practice Location

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