Provider Demographics
NPI:1053645689
Name:PELC, TRICIA LEE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:LEE
Last Name:PELC
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:LEE
Other - Last Name:HURTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 PALERMO DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-7206
Mailing Address - Country:US
Mailing Address - Phone:814-449-9469
Mailing Address - Fax:814-381-2215
Practice Address - Street 1:2500 PALERMO DR STE 3
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-7206
Practice Address - Country:US
Practice Address - Phone:814-449-9469
Practice Address - Fax:814-381-2215
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004650101YP2500X
PAPC004846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9533493OtherAETNA
VA1053645689OtherVA PREMIER (CHARTERED HEALTH)
PA102974373-0017Medicaid
VA1053645689OtherANTHEM
VA600615-752OtherMAGELLAN
VA1053645689OtherSENTARA