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NPI Code Detail

MEDICARE: JARITA MICKEL PITTMAN LPC-MHSP

MEDICARE: JARITA MICKEL PITTMAN LPC-MHSP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor5885TN

General Provider Information

NPI Number : 1831314939
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARITA MICKEL PITTMAN LPC-MHSP
Provider Business Mailing Address
First Line : 6000 POPLAR AVE STE 250
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-3974
Country : US
Telephone Number : 901-627-1289
Fax Number : 870-972-4911
Provider Business Practice Location Address
First Line : 6000 POPLAR AVE STE 250
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-3974
Country : US
Telephone Number : 901-627-1289
Fax Number : 870-972-4911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 09/25/2024

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