Provider Demographics
NPI:1558758219
Name:PECK, JANELLE LEE (MA, LEP)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:LEE
Last Name:PECK
Suffix:
Gender:F
Credentials:MA, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4069 GUILFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-5007
Mailing Address - Country:US
Mailing Address - Phone:209-968-5553
Mailing Address - Fax:
Practice Address - Street 1:4069 GUILFORD AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-5007
Practice Address - Country:US
Practice Address - Phone:209-968-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3262103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool