Provider Demographics
NPI:1588378426
Name:PEICH, STEVAN (MSCP-MFT)
Entity type:Individual
Prefix:MR
First Name:STEVAN
Middle Name:
Last Name:PEICH
Suffix:
Gender:M
Credentials:MSCP-MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1505
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-8505
Mailing Address - Country:US
Mailing Address - Phone:808-636-4964
Mailing Address - Fax:
Practice Address - Street 1:98-211 PALI MOMI ST STE 635
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4322
Practice Address - Country:US
Practice Address - Phone:808-636-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-811106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist