Provider Demographics
NPI:1659138873
Name:PELT, ADRIANNE
Entity Type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:
Last Name:PELT
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 1:419 STANDARD ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3038
Mailing Address - Country:US
Mailing Address - Phone:310-980-9142
Mailing Address - Fax:
Practice Address - Street 1:7891 LA TIJERA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3145
Practice Address - Country:US
Practice Address - Phone:310-670-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist