Provider Demographics
NPI:1639528789
Name:PETTIS COUNSELING, PLLC
Entity Type:Organization
Organization Name:PETTIS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:PETTIS
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-222-6714
Mailing Address - Street 1:505 N SAM HOUSTON PKWY E
Mailing Address - Street 2:SUITE 154
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4018
Mailing Address - Country:US
Mailing Address - Phone:281-222-6714
Mailing Address - Fax:832-777-6031
Practice Address - Street 1:505 N SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE 154
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4018
Practice Address - Country:US
Practice Address - Phone:281-222-6714
Practice Address - Fax:832-777-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X, 101YM0800X, 101YP2500X, 101YS0200X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127584803Medicaid