Individual
PEGGY SMITH PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
2130 WILLIE GROCE RD, GLASGOW, KY 42141-7831
(270) 791-2178
(270) 710-1794
Mailing address
2130 WILLIE GROCE RD, GLASGOW, KY 42141-7831
(270) 791-2178
(270) 710-1794
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
0615
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000537338
ANTHEM BLUE CROSS/BLUE SH
KY
01
—
11508376
CAQH ID
KY
05
—
7100059630
—
KY
05
—
7100059670
—
KY
Enumeration date
12/15/2005
Last updated
11/17/2009
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