Provider Demographics
NPI:1316156052
Name:THIEL, PEGGY NICOLE (LAC, MFT)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:NICOLE
Last Name:THIEL
Suffix:
Gender:F
Credentials:LAC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MEADOW PARK CIR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2946
Mailing Address - Country:US
Mailing Address - Phone:650-380-6831
Mailing Address - Fax:650-380-6831
Practice Address - Street 1:29 MEADOW PARK CIR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2946
Practice Address - Country:US
Practice Address - Phone:650-380-6831
Practice Address - Fax:650-380-6831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4802171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist