Provider Demographics
NPI:1528763265
Name:PEACH TREE COUNSELING, LLC
Entity type:Organization
Organization Name:PEACH TREE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-478-4217
Mailing Address - Street 1:1206 W SOUTH JORDAN PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5511
Mailing Address - Country:US
Mailing Address - Phone:385-253-8002
Mailing Address - Fax:385-275-0017
Practice Address - Street 1:1206 W SOUTH JORDAN PKWY STE C
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5511
Practice Address - Country:US
Practice Address - Phone:385-253-8002
Practice Address - Fax:385-275-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty