Individual ProviderHeather PeacockCounselorBehavioral Health & Social Service ProvidersPractice Address11035 NE Sandy Blvd, Portland, OR 97220-2553(503) 258-4200(209) 743-2898PECOS EnrollmentBased on the most recent information from CMS, provider Heather Peacock does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1225499197Provider TypeIndividualFull NamePeacock, HeatherGenderFemaleSole ProprietorYesEnumeration Date3/18/2016Last Updated3/18/2016Contact InformationPractice LocationPractice Address11035 NE Sandy Blvd, Portland, OR 97220-2553Phone(503) 258-4200FaxUnlisted FaxMailing LocationMailing Address12328 NW Barnes Rd, Apt. 442, Portland, OR 97229-6065Phone(209) 743-2898FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer