Provider Demographics
NPI:1952040784
Name:PELSTON, HARLIE BROOKE
Entity Type:Individual
Prefix:MS
First Name:HARLIE
Middle Name:BROOKE
Last Name:PELSTON
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 1:570 NEW CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-8251
Mailing Address - Country:US
Mailing Address - Phone:270-634-4338
Mailing Address - Fax:
Practice Address - Street 1:570 NEW CONCORD RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-8251
Practice Address - Country:US
Practice Address - Phone:270-634-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician