Individual ProviderJerell Akeem PettwayMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address3850 Crenshaw Blvd, Los Angeles, CA 90008-1821(323) 751-3026PECOS EnrollmentBased on the most recent information from CMS, provider Jerell Akeem Pettway does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1700341476Provider TypeIndividualFull NamePettway, Jerell AkeemGenderMaleSole ProprietorYesEnumeration Date2/6/2019Last Updated10/11/2023Contact InformationPractice LocationPractice Address3850 Crenshaw Blvd, Los Angeles, CA 90008-1821Phone(323) 751-3026FaxUnlisted FaxMailing LocationMailing Address3850 Crenshaw Blvd, Los Angeles, CA 90008-1821Phone(323) 751-3026FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicense137903CaliforniaCode171M00000XDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer