Healthcare Provider Details

I. General information

NPI: 1184227092
Provider Name (Legal Business Name): GEORGE T. PITTENGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 N RIDGEWAY DR STE 101
CLEBURNE TX
76033-4020
US

IV. Provider business mailing address

190 N RIDGEWAY DR STE 101
CLEBURNE TX
76033-4020
US

V. Phone/Fax

Practice location:
  • Phone: 817-499-3389
  • Fax:
Mailing address:
  • Phone: 817-624-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: GEORGE T PITTENGER
Title or Position: OWNER, CLINICAL DIRECTOR
Credential: MA, LPC
Phone: 682-916-2043