MEDICARE: MICHAEL R. PITTS, PSY.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1052	NM

General Provider Information

NPI Number	:	1265683882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL R. PITTS, PSY.D., LLC

Provider Business Mailing Address
First Line	:	1395 MISSOURI AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5327
Country	:	US
Telephone Number	:	575-522-5466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1395 MISSOURI AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5327
Country	:	US
Telephone Number	:	575-522-5466
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL R. PITTS
Credential	:	PSY.D.
Telephone Number	:	575-522-5466

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	10/01/2008

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