Healthcare Provider Details

I. General information

NPI: 1366060717
Provider Name (Legal Business Name): PELT CLINIC FOR ADDICTION AND MENTAL HEALTH RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 NORTHWOODS BLVD STE B1
COLUMBUS OH
43235-4727
US

IV. Provider business mailing address

134 NORTHWOODS BLVD STE B1
COLUMBUS OH
43235-4727
US

V. Phone/Fax

Practice location:
  • Phone: 614-846-6611
  • Fax: 614-846-6662
Mailing address:
  • Phone: 614-846-6611
  • Fax: 614-846-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALVIN D. PELT
Title or Position: OWNER
Credential: MD
Phone: 614-746-1850