Healthcare Provider Details

I. General information

NPI: 1689759391
Provider Name (Legal Business Name): CAREY EDWARD PITTSON GUIDANCE COUNSELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20740 S ELLSWORTH RD
QUEEN CREEK AZ
85242-9058
US

IV. Provider business mailing address

19108 E ORIOLE WAY
QUEEN CREEK AZ
85242-6881
US

V. Phone/Fax

Practice location:
  • Phone: 480-759-1087
  • Fax:
Mailing address:
  • Phone: 480-759-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: