Provider Demographics
NPI:1659365351
Name:FITTS, MICHAEL (PSY D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FITTS
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4500
Mailing Address - Country:US
Mailing Address - Phone:870-862-2489
Mailing Address - Fax:870-881-4497
Practice Address - Street 1:460 W OAK ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4500
Practice Address - Country:US
Practice Address - Phone:870-862-2489
Practice Address - Fax:870-881-4497
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR001P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U602Medicare ID - Type UnspecifiedPROVIDER ID #