Provider Demographics
NPI:1518219005
Name:PITTMAN PSYCHIATRY AND RECOVERY, PLLC
Entity Type:Organization
Organization Name:PITTMAN PSYCHIATRY AND RECOVERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:682-651-5320
Mailing Address - Street 1:1000 YUKON DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6348
Mailing Address - Country:US
Mailing Address - Phone:682-651-5320
Mailing Address - Fax:817-225-2408
Practice Address - Street 1:8215 WESTCHESTER DR STE 307
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6117
Practice Address - Country:US
Practice Address - Phone:682-651-5320
Practice Address - Fax:817-225-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8058261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1679609093OtherNPI OF PRACTICING PHYSICIAN