=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285945766
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOROTHY C PETTIGREW PSYD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2010
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4615 SOUTHWEST FWY 430
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77027-7108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-218-6855
-----------------------------------------------------
Fax | 713-218-6983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 310035
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77231-0035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-218-6855
-----------------------------------------------------
Fax | 713-218-6983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. DOROTHY CAROL PETTIGREW
-----------------------------------------------------
Credential | PSY. D
-----------------------------------------------------
Telephone | 713-218-6855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 22570
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------