Pettus, Thomas Bernard

Pettus, Thomas Bernard is an sole proprietor health care provider with primary practice located at 25153 Lindenwood Ln , Southfield MI 48033-6189. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Social Worker. Behavioral Health & Social Service Providers / Counselor is his primary health care specialty. Pettus, Thomas Bernard can be contacted via phone (313) 702-1459.

Contact Information

Primary practice address
25153 Lindenwood Ln Southfield MI 48033-6189
Phone: (313) 702-1459
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X 6401008172 Michigan
Behavioral Health & Social Service Providers / Social Worker 104100000X 6802061866 Michigan

Profile Details

NPI number 1861503112
LBN Legal business name Pettus, Thomas Bernard
Credentials LLPC, LBS.W.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 31st, 2006
Last updated Jun 25th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861503112 NPPES
Michigan Other 6801061866 STATE LICENSE
Michigan Other 6401008172 STATE LICENSE

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