Provider Demographics
NPI:1477667871
Name:PICHITINO, JOHN P (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:PICHITINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N US HIGHWAY 87
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-0283
Mailing Address - Country:US
Mailing Address - Phone:432-267-8216
Mailing Address - Fax:432-268-7790
Practice Address - Street 1:1901 HIGHWAY 87 N
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-0283
Practice Address - Country:US
Practice Address - Phone:432-267-8216
Practice Address - Fax:432-268-7790
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23510103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO81216P6Medicaid
TXPO81216P6Medicaid
TX81216PMedicare PIN