Provider Demographics
NPI:1710399704
Name:PESEK, JON THOMAS II (LPC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:THOMAS
Last Name:PESEK
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:PESEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:277 VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080-4028
Mailing Address - Country:US
Mailing Address - Phone:205-624-3076
Mailing Address - Fax:844-835-1972
Practice Address - Street 1:277 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-4028
Practice Address - Country:US
Practice Address - Phone:205-624-3076
Practice Address - Fax:844-835-1972
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3568101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL182873Medicaid