Healthcare Provider Details

I. General information

NPI: 1124707617
Provider Name (Legal Business Name): MARY ALICE PELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MARKET ST
STEUBENVILLE OH
43952-2153
US

IV. Provider business mailing address

505 W PLAIN ST
MINERVA OH
44657-1849
US

V. Phone/Fax

Practice location:
  • Phone: 740-314-5339
  • Fax: 740-314-5527
Mailing address:
  • Phone: 330-414-0359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.190212
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005502
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: