LISA PEACOCK (NPI# 1629310990) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629310990 |
| Entity Type | Individual |
| Full Name | LISA PEACOCK |
| Credential | LMFT |
| Practice Address |
4433 Ne 35 Place Portland OR 97211 |
| Mailing Address |
4433 Ne 35th Pl Portland OR 97211-8266 |
| Practice Telephone | 3109465567 |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2016-02-23 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
T1001 | OR | Behavioral Health & Social Service Providers |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
51797 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710245006 | Lisa Martinez Peacock | Social Worker | 8001 Shawnee Mission Pkwy, Suite 250c, Merriam, KS 66202-2966 | 2012-04-24 |
| 1134768211 | Lisa Peacock | Behavior Technician | 27777 Inkster Rd, Farmington Hills, MI 48334-5326 | 2020-01-06 |
| 1578059309 | Lisa Lynn3 Peacock | Health Educator | 10423 Centurion Pkwy N, Jacksonville, FL 32256-0527 | 2018-07-04 |
| 1952475287 | Lisa Marie Peacock | Nurse Practitioner | 2325 Garfield Rd N, Traverse City, MI 49686-5127 | 2006-11-20 |
| 1295721462 | Lisa Marie Peacock | Obstetrics & Gynecology | 3700 Saint Charles Ave, 5th Floor, New Orleans, LA 70115-4637 | 2005-09-23 |
| Street Address |
4433 NE 35 PLACE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386104586 | Rachel Joy Kendall | Counselor | 5257 Nw Martin Luther King Jr. Blvd, 202e, Portland, OR 97211 | 2019-03-22 |
| 1073014601 | Kelli Minton | Behavior Technician | 7035 Ne 9th Ave, Portland, OR 97211 | 2018-02-28 |
| 1083145726 | Warren H Baumann | Registered Nurse | 854 Ne Simpson St, Portland, OR 97211 | 2017-03-24 |
| 1407277411 | Regina Barnett | Case Manager/Care Coordinator | 509 Ne Alberta St., Portland, OR 97211 | 2013-12-17 |
| 1578905964 | Carmel Therese Irving | Social Worker | 5912 Ne 16th Ave, Portland, OR 97211 | 2013-07-25 |
| 1285907915 | Michele Karen Koder | Pharmacist | 3529 Ne Martin Luther King, Jr. Blvd., Portland, OR 97211 | 2012-02-10 |
| 1629368196 | Alexis Miranda Barker | Massage Therapist | 4929 Ne 30th Ave, Zen Space Healing, Portland, OR 97211 | 2011-04-18 |
| 1396041760 | Kara Ann Fuerst | Specialist | 3325 Ne Prescott, Portland, OR 97211 | 2011-02-02 |
| 1063746337 | Laura K Elvers | Pharmacist | 6116 Ne Mlk, Portland, OR 97211 | 2009-09-18 |
| 1871725374 | Vernon Santos Tionquiao | Occupational Therapist | 319 Ne Russet Street, Portland, OR 97211 | 2009-08-17 |
| Find all providers in zip 97211 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336748243 | Jessica M Feinsmith | Counselor | 6530 N Williams Ave, Portland, OR 97217-1924 | 2020-10-21 |
| 1720687809 | Karissa Myriah Gregory | Counselor | 14255 Se Rupert Dr, Portland, OR 97267-1211 | 2020-10-20 |
| 1528667904 | Zuzana Sakova | Counselor | 819 Se Morrison St Ste 225, Portland, OR 97214-6311 | 2020-10-18 |
| 1891302238 | Nina Landey | Counselor | 120 Se 53rd Ave, Portland, OR 97215-1204 | 2020-09-29 |
| 1902412166 | Peter H Addy LLC | Counselor | 524 N Tillamook St Ste 102b, Portland, OR 97227-1993 | 2020-09-22 |
| 1326654765 | Naomi Painter | Counselor | 1925 Ne 19th Ave Apt 8a, Portland, OR 97212-4526 | 2020-09-21 |
| 1750996104 | Sara Fuller | Counselor | 3016 Ne 70th Ave, Portland, OR 97213-5802 | 2020-09-12 |
| 1114532983 | Matthew W Cronin | Counselor | 1122 Ne 122nd Ave Ste 200, Portland, OR 97230-2081 | 2020-09-09 |
| 1447865381 | Luke Colbourn | Counselor | 2705 E Burnside St Ste 206, Portland, OR 97214-1768 | 2020-09-08 |
| 1710599774 | Abigail Kathryn Ernst | Counselor | 1020 Sw Taylor St # 100, Portland, OR 97205-2543 | 2020-08-20 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.