Provider Demographics
NPI:1194819813
Name:PETTY, MARY POMEROY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:POMEROY
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 1:1815 BISSONNET
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005
Mailing Address - Country:US
Mailing Address - Phone:713-528-2732
Mailing Address - Fax:713-528-4579
Practice Address - Street 1:1118 BARKDULL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006
Practice Address - Country:US
Practice Address - Phone:281-447-0847
Practice Address - Fax:713-528-4579
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional