Provider Demographics
NPI:1942739073
Name:PEONY COUNSELING
Entity type:Organization
Organization Name:PEONY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY-HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:214-810-1836
Mailing Address - Street 1:1517 N WATERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2935
Mailing Address - Country:US
Mailing Address - Phone:214-236-7328
Mailing Address - Fax:
Practice Address - Street 1:718 W ARAPAHO RD STE 100
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4160
Practice Address - Country:US
Practice Address - Phone:214-236-7328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX705111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty