1770096158 NPI number — PEAK HLPA, LLC

Table of content: MELANIE JAYNE NIMMO LPCC (NPI 1467977645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770096158 NPI number — PEAK HLPA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEAK HLPA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770096158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 HOUSTON ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76102-6226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-350-1031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4315 INDEPENDENCE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHNECKSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18078-2587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-378-3796
Provider Business Practice Location Address Fax Number:
214-594-9760
Provider Enumeration Date:
11/08/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ENGLISH
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
972-378-3796

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  39D2136329 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)