Provider Demographics
NPI:1104023274
Name:PETTY, TAMARA K (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:K
Last Name:PETTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17215 APRIL GLEN CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-1362
Mailing Address - Country:US
Mailing Address - Phone:281-859-9699
Mailing Address - Fax:
Practice Address - Street 1:17215 APRIL GLEN CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-1362
Practice Address - Country:US
Practice Address - Phone:281-859-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-30
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60417101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health