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1619770260 NPI number — JESSICA R PELTIER MA LLC

NPI Number: 1619770260
Health Care Provider/Practitioner: JESSICA R PELTIER MA LLC

Information about “1619770260” NPI (JESSICA R PELTIER MA LLC) exists in 1619770260 in HTML format HTML  |  1619770260 in plain Text format TXT  |  1619770260 in PDF (Portable Document Format) PDF  |  1619770260 in an XML format XML  formats.

NPI Number : 1619770260 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619770260",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PELTIER",
    "FirstName": "JESSICA",
    "MiddleName": "R",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MA LLC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3160 FIVE POINTS DR UNIT 107",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AUBURN HILLS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48326-2371",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "586-808-1490",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1460 WALTON BLVD STE 60",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROCHESTER HILLS",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48309-1729",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-608-4514",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/29/2025",
    "LastUpdateDate": "12/18/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": "6451024105",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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