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General NPI Number Information
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NPI Number | 1689932170
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Entity Type | Organization
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Legal Business Name | PETOSKEY CENTER, P.C.
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 730 N POST OAK RD 301
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City | HOUSTON
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State | TX
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Zip | 77024-3842
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Country | US
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Telephone | 832-202-2283
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 366
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City | HOUSTON
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State | TX
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Zip | 77001-0366
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Country | US
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Telephone | 832-202-2283
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JENNIFER MARKEY
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Credential | PHD
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Telephone | 832-202-2226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 34262
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License Number State | TX
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