1053471805 NPI number — DR. RICHARD J. PITTS PSY.D.

Table of content: DR. RICHARD J. PITTS PSY.D. (NPI 1053471805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053471805 NPI number — DR. RICHARD J. PITTS PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITTS
Provider First Name:
RICHARD
Provider Middle Name:
J.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053471805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DR. RICHARD J. PITTS
Provider Second Line Business Mailing Address:
2801 FORTUNA DR.
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78738-5427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-263-2850
Provider Business Mailing Address Fax Number:
512-263-8194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3355 BEE CAVE RD
Provider Second Line Business Practice Location Address:
SUITE 610
Provider Business Practice Location Address City Name:
WEST LAKE HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-6775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-626-6511
Provider Business Practice Location Address Fax Number:
512-263-2850
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  24315 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 184304701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com