MEDICARE: HAILEIGH PETTIGREW 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	101Y00000X	Counselor	87054	TX

General Provider Information

NPI Number	:	1568241925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEIGH PETTIGREW LPC

Provider Business Mailing Address
First Line	:	540 HEIGHTS BLVD STE 224
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2552
Country	:	US
Telephone Number	:	214-886-8962
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 HEIGHTS BLVD STE 224
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2552
Country	:	US
Telephone Number	:	214-886-8962
Fax Number	:

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

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	02/12/2024

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