| Doctor Name: | MR. MICHAEL WAYNE PELLECCHIA |
| NPI Number: | 1043399116 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW LCSW |
| License Number: | 18753 |
| Business Practice Address: | 2526 Seymour Ave Cheyenne, WY - 820013159 |
| Business Phone Number: | 3076349653 |
| Business Fax Number: | 3076388256 |
| Mailing Address: | 2526 Seymour Ave, CHEYENNE |
| State: | WY |
| Postal Code: | 820013159 |
| Phone Number: | 3076349653 |
| Fax Number: | 3076388256 |
| NPI Enumeration Date: | 11/02/2006 |
| NPI Last Update Date: | 04/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 18753 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |