Provider Demographics
NPI:1093907503
Name:FELLOWSHIP COUNSELING P.C.
Entity Type:Organization
Organization Name:FELLOWSHIP COUNSELING P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA,MSW,ACSW
Authorized Official - Phone:906-786-4733
Mailing Address - Street 1:1100 LUDINGTON ST STE 306
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3500
Mailing Address - Country:US
Mailing Address - Phone:906-786-4733
Mailing Address - Fax:
Practice Address - Street 1:1100 LUDINGTON ST STE 306
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3500
Practice Address - Country:US
Practice Address - Phone:906-786-4733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801062626106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008971370OtherBLUE CROSS BLUE SHIELD
MI8008971370OtherBLUE CROSS BLUE SHIELD