Provider Demographics
NPI:1588777353
Name:PELLETIER, JULIE MARIE (PSYD, HSPP)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MARIE
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51635 TERRI BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7269
Mailing Address - Country:US
Mailing Address - Phone:574-651-9834
Mailing Address - Fax:
Practice Address - Street 1:314 W CATALPA DR
Practice Address - Street 2:SUITE E
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3194
Practice Address - Country:US
Practice Address - Phone:574-254-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041979A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical