Provider Demographics
NPI:1730264755
Name:ST. CLAIR, PEGGY A (LMHP, CPC, LADC)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:A
Last Name:ST. CLAIR
Suffix:
Gender:F
Credentials:LMHP, CPC, LADC
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:A
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1909 N EASTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-6998
Mailing Address - Country:US
Mailing Address - Phone:402-379-4311
Mailing Address - Fax:402-379-9519
Practice Address - Street 1:200 N 34TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3197
Practice Address - Country:US
Practice Address - Phone:402-371-3044
Practice Address - Fax:402-371-9643
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE774101Y00000X
NE120101YA0400X
NE1261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84696OtherBCBS OF NEBRASKA
NE47083165927Medicaid
NE47083165926Medicaid