Provider Demographics
NPI:1427746882
Name:PEAK WELLNESS GROUP LLC
Entity type:Organization
Organization Name:PEAK WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPOTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:307-413-1355
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-0343
Mailing Address - Country:US
Mailing Address - Phone:435-200-5507
Mailing Address - Fax:
Practice Address - Street 1:168 ANDREWS LN
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9109
Practice Address - Country:US
Practice Address - Phone:307-413-1355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty