Provider Demographics
NPI:1033720321
Name:PELTOLA, JEANETTE FAY (PLC,MA)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:FAY
Last Name:PELTOLA
Suffix:
Gender:F
Credentials:PLC,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 HARBOR CT
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-9355
Mailing Address - Country:US
Mailing Address - Phone:231-632-1370
Mailing Address - Fax:
Practice Address - Street 1:968 HARBOR CT
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-9355
Practice Address - Country:US
Practice Address - Phone:231-632-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003877101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty