Provider Demographics
NPI:1528366903
Name:PEAK MENTAL WELLNESS AND COUNSELING LLC
Entity type:Organization
Organization Name:PEAK MENTAL WELLNESS AND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-724-9276
Mailing Address - Street 1:2805 BLAINE ST
Mailing Address - Street 2:STE 120
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4599
Mailing Address - Country:US
Mailing Address - Phone:208-459-4412
Mailing Address - Fax:208-454-7296
Practice Address - Street 1:2805 BLAINE ST
Practice Address - Street 2:STE 120
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4599
Practice Address - Country:US
Practice Address - Phone:208-459-4412
Practice Address - Fax:208-454-7296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health