Provider Demographics
NPI:1316927197
Name:LAURIE AMES PETTY, M.ED., LPC, P.A.
Entity type:Organization
Organization Name:LAURIE AMES PETTY, M.ED., LPC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:AMES
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, PA
Authorized Official - Phone:214-202-4687
Mailing Address - Street 1:PO BOX 180244
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-0244
Mailing Address - Country:US
Mailing Address - Phone:214-202-4687
Mailing Address - Fax:214-390-8112
Practice Address - Street 1:14833 MIDWAY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4955
Practice Address - Country:US
Practice Address - Phone:214-202-4687
Practice Address - Fax:214-390-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty