Individual
JOHNNIE PECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24624 INTERSTATE 45 N, #200, SPRING, TX 77386-4084
(832) 799-4954
Mailing address
24624 INTERSTATE 45 N, #200, SPRING, TX 77386-4084
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05115620
—
TX
Enumeration date
03/10/2017
Last updated
03/10/2017
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