Provider Demographics
NPI:1285945766
Name:DOROTHY C. PETTIGREW, PSY.D.,PC
Entity type:Organization
Organization Name:DOROTHY C. PETTIGREW, PSY.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:PETTIGREW
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:713-218-6855
Mailing Address - Street 1:PO BOX 310035
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77231-0035
Mailing Address - Country:US
Mailing Address - Phone:713-218-6855
Mailing Address - Fax:713-218-6983
Practice Address - Street 1:4615 SOUTHWEST FWY
Practice Address - Street 2:430
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7108
Practice Address - Country:US
Practice Address - Phone:713-218-6855
Practice Address - Fax:713-218-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000457-01Medicaid
TX00SD96Medicare PIN