# PEAK BEHAVIORAL HEALTH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053879023
- **Authorized official:** PORSCHE PEAK LMFT, LADC (DIRECTOR, CLINICAL THERAPIST)
- **Authorized official phone:** (651) 493-2055

## Contact information

- **Practice address:** 2864 MIDDLE ST STE 100, LITTLE CANADA, MN 55117-1411
- **Practice address phone:** (651) 493-2055
- **Practice address fax:** (651) 340-8632
- **Mailing address:** 2864 MIDDLE ST STE 100, LITTLE CANADA, MN 55117-1411
- **Mailing address phone:** (651) 493-2055
- **Mailing address fax:** (651) 340-8632

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | NULL | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | — | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | NULL | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |
| 172V00000X | Community Health Worker | — | NULL | — |
| 172V00000X | Community Health Worker | — | — | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | NULL | — |

## Other

- **Enumeration date:** 03/07/2019
- **Last updated:** 03/25/2019