Provider Demographics
NPI:1487984373
Name:PELZ CLINIC, LLC
Entity type:Organization
Organization Name:PELZ CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PELZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:641-691-1166
Mailing Address - Street 1:206 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2737
Mailing Address - Country:US
Mailing Address - Phone:641-691-1166
Mailing Address - Fax:
Practice Address - Street 1:206 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-2737
Practice Address - Country:US
Practice Address - Phone:641-691-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1067251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health