Provider Demographics
NPI:1447530001
Name:ROBERT E PELC PHD ABPP PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ROBERT E PELC PHD ABPP PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:PELC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-388-6761
Mailing Address - Street 1:4251 S NATCHES CT STE A
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-8603
Mailing Address - Country:US
Mailing Address - Phone:303-388-6761
Mailing Address - Fax:303-388-0132
Practice Address - Street 1:4251 S NATCHES CT STE A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-8603
Practice Address - Country:US
Practice Address - Phone:303-388-6761
Practice Address - Fax:303-388-0132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO531103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty