MEDICARE: MR. MICHAEL ANTHONY PICKETT MA

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	101YP2500X	Professional Counselor	4576	SC
2	101YP2500X	Professional Counselor	TPMC5097	FL
3	101YP2500X	Professional Counselor	22598	NC

General Provider Information

NPI Number	:	1831425123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANTHONY PICKETT MA

Provider Business Mailing Address
First Line	:	200 KESTREL COURT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588
Country	:	US
Telephone Number	:	843-215-1807
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 KESTREL COURT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588
Country	:	US
Telephone Number	:	843-215-1807
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	02/13/2026

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