Provider Demographics
NPI:1609074699
Name:PELKING, SCOTT IRWIN (LPC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:IRWIN
Last Name:PELKING
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 THUNDERBIRD DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3829
Mailing Address - Country:US
Mailing Address - Phone:915-845-3122
Mailing Address - Fax:915-845-4165
Practice Address - Street 1:300 THUNDERBIRD DR
Practice Address - Street 2:SUITE 12
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3829
Practice Address - Country:US
Practice Address - Phone:915-845-3122
Practice Address - Fax:915-845-4165
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional