Bryan James Peacock, L.P.C.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3957-125 Issued in WI

Practice address

11904 W North Ave
Suite # 110
Wauwatosa, WI 53226-2062

Phone

(414) 248-4347

NPI assigned

May 19, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• New Life Resources, Inc.

  • Psychiatry Physician
  • Waukesha, WI
  • NPI 1225061997

  Professional

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242691200000",
    "number": "1780819797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N67W24937 STONEGATE CT",
            "address_2": "#203",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "530892585",
            "telephone_number": "414-840-7247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11904 W NORTH AVE",
            "address_2": "SUITE # 110",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262062",
            "telephone_number": "414-248-4347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "BRYAN",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "L.P.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-19",
        "last_updated": "2009-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3957-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela M Paul, NP
• Emily Paul
• Jay Paunovich
• Trisha Pavicich
• Michael Garrett Payne, D.D.S.
• James Frank Pechloff Jr., DDS
• Dean Pecor
• Pediatric Psychology Associates LLC (Autism Behavioral Network)
• Pediatric Rehabilitation Medicine Associates,LLC
• Kelsey Paige Pendleton

• Professional Counselor in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.