Provider Demographics
NPI:1174080923
Name:PEACETREE, VERONIKA ANNE (LPCC)
Entity type:Individual
Prefix:
First Name:VERONIKA
Middle Name:ANNE
Last Name:PEACETREE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMS-QUESTA HEALTH CENTER
Mailing Address - Street 2:2573 STATE HWY522
Mailing Address - City:QUESTA
Mailing Address - State:NM
Mailing Address - Zip Code:87566-0290
Mailing Address - Country:US
Mailing Address - Phone:575-586-0331
Mailing Address - Fax:575-586-0519
Practice Address - Street 1:PMS-QUESTA HEALTH CENTER
Practice Address - Street 2:2573 STATE HWY522
Practice Address - City:QUESTA
Practice Address - State:NM
Practice Address - Zip Code:87566-0290
Practice Address - Country:US
Practice Address - Phone:575-586-0331
Practice Address - Fax:575-586-0519
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0201811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional