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1518167394

NPI Code Detail

MEDICARE: DR. DANIEL JOHN PELAK LPCC

MEDICARE: DR. DANIEL JOHN PELAK LPCC

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	P15112129	AR
2	101YP2500X	Professional Counselor	5511	CO
3	106H00000X	Marriage & Family Therapist	CMF0187581	NM
4	101YP2500X	Professional Counselor	CCMH0183181	NM

General Provider Information

NPI Number	:	1518167394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JOHN PELAK LPCC

Provider Business Mailing Address
First Line	:	1040 SAKELARES BLVD
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-3819
Country	:	US
Telephone Number	:	505-287-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 SAKELARES BLVD
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-3819
Country	:	US
Telephone Number	:	318-245-5791
Fax Number	:

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

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	11/15/2021

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Directions to “ DR. DANIEL JOHN PELAK LPCC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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