Provider Demographics
NPI:1265633010
Name:PICTON, THOMAS D JR (M DIV)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:PICTON
Suffix:JR
Gender:M
Credentials:M DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300246
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203
Mailing Address - Country:US
Mailing Address - Phone:303-370-0035
Mailing Address - Fax:303-370-0036
Practice Address - Street 1:5354 PLANK ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70892-3900
Practice Address - Country:US
Practice Address - Phone:225-355-3377
Practice Address - Fax:225-355-6200
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA499106H00000X
TX1220106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist