Active NPI
Melinda Kay Pettit
- Addiction (Substance Use Disorder) Counselor
- Tyler, TX
National Provider Identifier
1437605342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 12348
- Practice address
- 104 Jordan Plaza Blvd
Suite 402-403
Tyler, TX 75704-2055 - Phone
- (903) 581-9472
- NPI assigned
- Aug 31, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 12348 | TX | Primary |
Addresses
Primary practice location
104 Jordan Plaza Blvd
Suite 402-403
Tyler, TX 75704-2055
Mailing address
104 Jordan Plaza Blvd
Suite 402-403
Tyler, TX 75704-2055
Phone (903) 581-9472
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12348 | Other | TX | LCDC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12348 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sabine Valley Regional MHMR Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Longview, TX
- NPI 1841835022
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472601600000",
"number": "1437605342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 JORDAN PLAZA BLVD",
"address_2": "SUITE 402-403",
"city": "TYLER",
"state": "TX",
"postal_code": "757042055",
"telephone_number": "903-581-9472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 JORDAN PLAZA BLVD",
"address_2": "SUITE 402-403",
"city": "TYLER",
"state": "TX",
"postal_code": "757042055",
"telephone_number": "903-581-9472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIT",
"first_name": "MELINDA",
"middle_name": "KAY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-31",
"last_updated": "2016-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "12348",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCDC",
"identifier": "12348",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.