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NPI Code Detail

MEDICARE: MRS. MARY POMEROY PETTY LPC

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
1101YP2500XProfessional Counselor02573TX

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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Directions to “ MRS. MARY POMEROY PETTY LPC” Practice Location

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