MEDICARE: MRS. MARY POMEROY PETTY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	02573	TX

General Provider Information

NPI Number	:	1194819813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY POMEROY PETTY LPC

Provider Business Mailing Address
First Line	:	1815 BISSONNET
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005
Country	:	US
Telephone Number	:	713-528-2732
Fax Number	:	713-528-4579

Provider Business Practice Location Address
First Line	:	1118 BARKDULL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006
Country	:	US
Telephone Number	:	281-447-0847
Fax Number	:	713-528-4579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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