Provider Demographics
NPI:1649489626
Name:PETTIGREW, PAMELA R (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 S WESTERN AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6215
Mailing Address - Country:US
Mailing Address - Phone:405-703-4420
Mailing Address - Fax:405-703-4499
Practice Address - Street 1:10601 S WESTERN AVE STE 109
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170
Practice Address - Country:US
Practice Address - Phone:405-703-4420
Practice Address - Fax:405-703-4499
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1649489626OtherNPI