Basic Information
| Provider Information | |||||||||
| NPI: | 1780015263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETTIT | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2875 | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486412875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898322165 | ||||||||
| FaxNumber: | 9898394376 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 W. WACKERLY | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898322165 | ||||||||
| FaxNumber: | 9898394376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2013 | ||||||||
| LastUpdateDate: | 12/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301015769 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.