Healthcare Provider Details

I. General information

NPI: 1669998597
Provider Name (Legal Business Name): SUSAN PELLETIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W MICHELTORENA ST STE A
SANTA BARBARA CA
93101-6526
US

IV. Provider business mailing address

630 W TEFFT ST UNIT 1630
NIPOMO CA
93444-7086
US

V. Phone/Fax

Practice location:
  • Phone: 323-673-1968
  • Fax:
Mailing address:
  • Phone: 323-673-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: