Provider Demographics
NPI:1871972521
Name:PELOT, KATY (LPC)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:PELOT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-3316
Mailing Address - Country:US
Mailing Address - Phone:313-995-6969
Mailing Address - Fax:
Practice Address - Street 1:2700 HAMLIN BLVD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2206
Practice Address - Country:US
Practice Address - Phone:313-561-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015710101Y00000X
MI6803086711171M00000X
MI6401018009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator