Provider Demographics
NPI:1710371042
Name:PEGRAM, RODNEY
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:
Last Name:PEGRAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2210
Mailing Address - Country:US
Mailing Address - Phone:832-916-1906
Mailing Address - Fax:
Practice Address - Street 1:3 SUGAR CREEK CENTER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-2210
Practice Address - Country:US
Practice Address - Phone:832-916-1906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor