Provider Demographics
NPI:1982002457
Name:PELLON COMMUNITY SERVICES INC.
Entity Type:Organization
Organization Name:PELLON COMMUNITY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHC/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PELLON
Authorized Official - Suffix:
Authorized Official - Credentials:MS,MHC
Authorized Official - Phone:786-712-9941
Mailing Address - Street 1:300 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4808
Mailing Address - Country:US
Mailing Address - Phone:786-712-9941
Mailing Address - Fax:
Practice Address - Street 1:300 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4808
Practice Address - Country:US
Practice Address - Phone:786-712-9941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty