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General NPI Number Information
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NPI Number | 1891046447
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Entity Type | Individual
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Provider Name | SCOTT MICHAEL PICKETT PHD
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Gender | Male
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Dates
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Enumeration Date | 09/23/2012
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 1202 CIRCLE DR
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City | TALLAHASSEE
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State | FL
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Zip | 32301-5712
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Country | US
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Telephone | 810-957-1319
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 CIRCLE DR
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City | TALLAHASSEE
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State | FL
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Zip | 32301-5712
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Country | US
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Telephone | 810-957-1319
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301013971
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY11000
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License Number State | FL
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