Provider Demographics
NPI:1417753468
Name:PETTIT, EMORI (PLMHP)
Entity type:Individual
Prefix:
First Name:EMORI
Middle Name:
Last Name:PETTIT
Suffix:
Gender:
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10704 S 15TH ST APT 2101
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4188
Mailing Address - Country:US
Mailing Address - Phone:405-434-7103
Mailing Address - Fax:
Practice Address - Street 1:546 A AVENUE
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048
Practice Address - Country:US
Practice Address - Phone:402-298-4215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health