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General NPI Number Information
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NPI Number | 1043314560
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Entity Type | Individual
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Provider Name | JOHN MANUEL PITA PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/20/2009
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Provider Practice Location Address
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Address Line | 900 HEDGCOXE RD
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City | PLANO
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State | TX
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Zip | 75025-2554
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Country | US
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Telephone | 972-765-2643
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Fax | 214-698-4497
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Provider Business Mailing Address
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Address Line | PO BOX 226464
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City | DALLAS
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State | TX
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Zip | 75222-6464
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Country | US
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Telephone | 972-765-2643
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Fax | 214-698-4497
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 24790
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License Number State | TX
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