Provider Demographics
NPI:1053896415
Name:PEAK THERAPEUTIC INC
Entity type:Organization
Organization Name:PEAK THERAPEUTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BOGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-837-3722
Mailing Address - Street 1:6760 CORPORATE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-5910
Mailing Address - Country:US
Mailing Address - Phone:951-837-3722
Mailing Address - Fax:719-631-0720
Practice Address - Street 1:6760 CORPORATE DR STE 140
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-5910
Practice Address - Country:US
Practice Address - Phone:951-837-3722
Practice Address - Fax:719-631-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000155112Medicaid