Healthcare Provider Details

I. General information

NPI: 1568123636
Provider Name (Legal Business Name): MILLICENT PITTS-LICENSED MARRIAGE & FAMILY THERAPIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2021
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TRUXTUN AVE STE 720
BAKERSFIELD CA
93301-5220
US

IV. Provider business mailing address

1430 TRUXTUN AVE STE 720
BAKERSFIELD CA
93301-5220
US

V. Phone/Fax

Practice location:
  • Phone: 661-717-6775
  • Fax: 866-812-6912
Mailing address:
  • Phone: 661-717-6775
  • Fax: 866-812-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MILLICENT PITTS
Title or Position: OWNER
Credential: LMFT
Phone: 661-748-1633