MEDICARE: DOROTHY C PETTIGREW PSYD PC

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	103TC0700X	Clinical Psychologist	22570	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285945766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOROTHY C PETTIGREW PSYD PC

Provider Business Mailing Address
First Line	:	PO BOX 310035
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77231-0035
Country	:	US
Telephone Number	:	713-218-6855
Fax Number	:	713-218-6983

Provider Business Practice Location Address
First Line	:	4615 SOUTHWEST FWY
Second Line	:	430
City	:	HOUSTON
State	:	TX
Zip	:	77027-7108
Country	:	US
Telephone Number	:	713-218-6855
Fax Number	:	713-218-6983

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. DOROTHY CAROL PETTIGREW
Credential	:	PSY. D
Telephone Number	:	713-218-6855

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	12/12/2025

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