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General NPI Number Information
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NPI Number | 1093907503
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Entity Type | Organization
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Legal Business Name | FELLOWSHIP COUNSELING P.C.
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 1100 LUDINGTON ST STE 306
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City | ESCANABA
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State | MI
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Zip | 49829-3500
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Country | US
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Telephone | 906-786-4733
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 LUDINGTON ST STE 306
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City | ESCANABA
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State | MI
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Zip | 49829-3500
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Country | US
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Telephone | 906-786-4733
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/COUNSELOR
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Name | MRS. PATRICIA J PELTZ
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Credential | M.A.,M.S.W.,ACSW
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Telephone | 906-786-4733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 6801062626
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License Number State | MI
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