Provider Demographics
NPI:1386981025
Name:WUNDERLICH, PEGGY (L P C)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:L P C
Other - Prefix:MRS
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:PIPKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:15015 MARLEBONE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-2021
Mailing Address - Country:US
Mailing Address - Phone:832-859-2417
Mailing Address - Fax:
Practice Address - Street 1:15015 MARLEBONE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-2021
Practice Address - Country:US
Practice Address - Phone:832-859-2417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health