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General NPI Number Information
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NPI Number | 1033636691
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Entity Type | Individual
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Provider Name | TERRELL DONNELL PICKETT
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Gender | Male
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 22490 N VANDERVEEN WAY
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City | MARICOPA
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State | AZ
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Zip | 85138-5569
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Country | US
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Telephone | 623-826-4195
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Fax | 602-279-1431
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Provider Business Mailing Address
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Address Line | PO BOX 16906
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City | PHOENIX
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State | AZ
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Zip | 85011-6906
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Country | US
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Telephone | 602-279-1427
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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