Individual
MR. BRYAN JAMES PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
11904 W NORTH AVE, SUITE # 110, WAUWATOSA, WI 53226-2062
(414) 248-4347
Mailing address
N67W24937 STONEGATE CT, #203, SUSSEX, WI 53089-2585
(414) 840-7247
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3957-125
WI
Other
Enumeration date
05/19/2009
Last updated
05/19/2009
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