Provider Demographics
NPI:1942553078
Name:PELTZER, ANICIA JANN
Entity Type:Individual
Prefix:
First Name:ANICIA
Middle Name:JANN
Last Name:PELTZER
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 1:94235 MOORE STREET
Mailing Address - Street 2:SUITE 412
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444
Mailing Address - Country:US
Mailing Address - Phone:541-247-4082
Mailing Address - Fax:
Practice Address - Street 1:94235 MOORE ST
Practice Address - Street 2:SUITE 412
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444-9699
Practice Address - Country:US
Practice Address - Phone:541-247-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health