Provider Demographics
| NPI: | 1053879023 |
|---|---|
| Name: | PEAK BEHAVIORAL HEALTH, LLC |
| Entity type: | Organization |
| Organization Name: | PEAK BEHAVIORAL HEALTH, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR, CLINICAL THERAPIST |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | PORSCHE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | PEAK |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | LMFT, LADC |
| Authorized Official - Phone: | 651-493-2055 |
| Mailing Address - Street 1: | 2864 MIDDLE ST STE 100 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LITTLE CANADA |
| Mailing Address - State: | MN |
| Mailing Address - Zip Code: | 55117-1411 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 651-493-2055 |
| Mailing Address - Fax: | 651-340-8632 |
| Practice Address - Street 1: | 2864 MIDDLE ST STE 100 |
| Practice Address - Street 2: | |
| Practice Address - City: | LITTLE CANADA |
| Practice Address - State: | MN |
| Practice Address - Zip Code: | 55117-1411 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 651-493-2055 |
| Practice Address - Fax: | 651-340-8632 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-03-07 |
| Last Update Date: | 2019-03-25 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 172V00000X | Other Service Providers | Community Health Worker | Group - Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | Group - Multi-Specialty |
