Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1245636497 |
---|---|
Provider Name | Elisabeth Pitts |
First Address | Enid, OK 73701-1208 |
Second Address | Enid, OK 73701-5673 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2014 |
Last Update Date | 18/11/2014 |