MEDICARE: MS. WHYKETHA N PETTIS LPC-IT

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	7601-226	WI

General Provider Information

NPI Number	:	1124911045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WHYKETHA N PETTIS LPC-IT

Provider Business Mailing Address
First Line	:	5508 W VLIET ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-2120
Country	:	US
Telephone Number	:	414-533-5589
Fax Number	:

Provider Business Practice Location Address
First Line	:	5508 W VLIET ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-2120
Country	:	US
Telephone Number	:	414-533-5589
Fax Number	:

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

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	05/30/2025

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