Provider Demographics
NPI:1649336389
Name:PELTZ, JANETTA LYN (MFT)
Entity type:Individual
Prefix:
First Name:JANETTA
Middle Name:LYN
Last Name:PELTZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JANETTA
Other - Middle Name:LYNN
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:3086 W RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220
Mailing Address - Country:US
Mailing Address - Phone:951-922-0442
Mailing Address - Fax:951-922-9598
Practice Address - Street 1:3086 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220
Practice Address - Country:US
Practice Address - Phone:951-922-0442
Practice Address - Fax:951-922-9598
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MFC27422106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist