Healthcare Provider Details

I. General information

NPI: 1619770260
Provider Name (Legal Business Name): JESSICA R PELTIER MA LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD STE 60
ROCHESTER HILLS MI
48309-1729
US

IV. Provider business mailing address

3160 FIVE POINTS DR UNIT 107
AUBURN HILLS MI
48326-2371
US

V. Phone/Fax

Practice location:
  • Phone: 248-608-4514
  • Fax:
Mailing address:
  • Phone: 586-808-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024105
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: