Provider Demographics
NPI:1962938506
Name:PEASE, CAROL (MS, CPC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:PEASE
Suffix:
Gender:F
Credentials:MS, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 N STOCKTON HILL RD
Mailing Address - Street 2:#103-449
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0595
Mailing Address - Country:US
Mailing Address - Phone:928-303-5155
Mailing Address - Fax:
Practice Address - Street 1:3880 N STOCKTON HILL RD
Practice Address - Street 2:#103-449
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0595
Practice Address - Country:US
Practice Address - Phone:928-303-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral