Provider Demographics
NPI:1386070266
Name:PEACHEY, JESSICA (LMHC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PEACHEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21769 COUNTY ROAD 45
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-5810
Mailing Address - Country:US
Mailing Address - Phone:574-361-7400
Mailing Address - Fax:
Practice Address - Street 1:17195 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1415
Practice Address - Country:US
Practice Address - Phone:574-277-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002486A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health