Healthcare Provider Details

I. General information

NPI: 1942879663
Provider Name (Legal Business Name): JOHN PITMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11518 N PORT WASHINGTON RD STE 202
MEQUON WI
53092-3443
US

IV. Provider business mailing address

11518 N PORT WASHINGTON RD STE 202
MEQUON WI
53092-3443
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-3495
  • Fax:
Mailing address:
  • Phone: 608-213-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number132296
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19437
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132296
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10089
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: