Provider Demographics
NPI:1104207265
Name:PELLERIN, JOY (LPC)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:PELLERIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25752 KINGSLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2086
Mailing Address - Country:US
Mailing Address - Phone:281-392-7505
Mailing Address - Fax:281-392-7560
Practice Address - Street 1:25752 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2086
Practice Address - Country:US
Practice Address - Phone:281-392-7505
Practice Address - Fax:281-392-7560
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71779322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children