Provider Demographics
NPI:1124238563
Name:PETZOLD, CARMEN C (PHD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:C
Last Name:PETZOLD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARMELETA
Other - Middle Name:
Other - Last Name:PETZOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:37 LEGEND LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2407
Mailing Address - Country:US
Mailing Address - Phone:713-935-0603
Mailing Address - Fax:713-935-0583
Practice Address - Street 1:9525 KATY FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1407
Practice Address - Country:US
Practice Address - Phone:713-263-0400
Practice Address - Fax:713-263-0333
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22664103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist