Provider Demographics
NPI:1619770260
Name:PELTIER, JESSICA R (MA LLC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:R
Last Name:PELTIER
Suffix:
Gender:
Credentials:MA LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 FIVE POINTS DR UNIT 107
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2371
Mailing Address - Country:US
Mailing Address - Phone:586-808-1490
Mailing Address - Fax:
Practice Address - Street 1:826 S LAPEER RD STE B
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6511
Practice Address - Country:US
Practice Address - Phone:248-572-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451024105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health