Provider Demographics
NPI:1003282641
Name:PITTMAN, JAMES (MS,PCMHT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:MS,PCMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4108
Mailing Address - Country:US
Mailing Address - Phone:601-473-2106
Mailing Address - Fax:601-473-2150
Practice Address - Street 1:604 HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4108
Practice Address - Country:US
Practice Address - Phone:601-473-2106
Practice Address - Fax:601-473-2150
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018209Medicaid