Provider Demographics
NPI:1902569924
Name:PEELER, KRISTINE (LCMHC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:PEELER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 LOG TOWN RD
Mailing Address - Street 2:
Mailing Address - City:EAST CALAIS
Mailing Address - State:VT
Mailing Address - Zip Code:05650-8276
Mailing Address - Country:US
Mailing Address - Phone:802-798-2714
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4257
Practice Address - Country:US
Practice Address - Phone:802-798-2714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health