Provider Demographics
NPI:1639301278
Name:PELES, SEUNGYEON MIKI
Entity Type:Individual
Prefix:
First Name:SEUNGYEON
Middle Name:MIKI
Last Name:PELES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HANNIBAL DR
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42262-9156
Mailing Address - Country:US
Mailing Address - Phone:931-206-1526
Mailing Address - Fax:
Practice Address - Street 1:1600 HANNIBAL DR
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:KY
Practice Address - Zip Code:42262-9156
Practice Address - Country:US
Practice Address - Phone:931-206-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-16
Last Update Date:2009-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst