Provider Demographics
NPI:1730306002
Name:PICKERING, JOHN W (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:PICKERING
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 1:7510 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-6726
Mailing Address - Country:US
Mailing Address - Phone:225-766-2822
Mailing Address - Fax:225-766-2823
Practice Address - Street 1:7510 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-6726
Practice Address - Country:US
Practice Address - Phone:225-766-2822
Practice Address - Fax:225-766-2823
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA# 516103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S673Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE