Basic Information
| Provider Information | |||||||||
| NPI: | 1467827212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EPPOLITO | ||||||||
| FirstName: | PEG | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMHC, CADC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HARRISON | ||||||||
| OtherFirstName: | PEGGY | ||||||||
| OtherMiddleName: | JEAN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LMHC, CADC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 800 5TH ST | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122342300 | ||||||||
| FaxNumber: | 7122342398 | ||||||||
| Practice Location | |||||||||
| Address1: | 3320 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511033200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122020777 | ||||||||
| FaxNumber: | 7122020780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2015 | ||||||||
| LastUpdateDate: | 12/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 05204 | IA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 001693 | IA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.