Provider Demographics
NPI:1194572818
Name:JACKSON PEAK COUNSELING, PLLC
Entity type:Organization
Organization Name:JACKSON PEAK COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LONGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-445-5703
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05251-0056
Mailing Address - Country:US
Mailing Address - Phone:802-445-5703
Mailing Address - Fax:
Practice Address - Street 1:143 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DORSET
Practice Address - State:VT
Practice Address - Zip Code:05251-2001
Practice Address - Country:US
Practice Address - Phone:802-445-5703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty