MEDICARE: MR. RONALD STANLEY PELT M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	678	NC

General Provider Information

NPI Number	:	1477760312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD STANLEY PELT M.S.

Provider Business Mailing Address
First Line	:	4400 PARK RD
Second Line	:	STE 330
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3139
Country	:	US
Telephone Number	:	704-529-1428
Fax Number	:	704-529-5917

Provider Business Practice Location Address
First Line	:	4400 PARK RD
Second Line	:	STE 330
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3139
Country	:	US
Telephone Number	:	704-529-1428
Fax Number	:	704-529-5917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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