Provider Demographics
NPI:1851422786
Name:PITT, PAULETTE D (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:D
Last Name:PITT
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:D
Other - Last Name:CIVICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:600 E TAYLOR ST
Mailing Address - Street 2:SUITE 4011
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2881
Mailing Address - Country:US
Mailing Address - Phone:903-893-0298
Mailing Address - Fax:903-892-6323
Practice Address - Street 1:600 E TAYLOR ST
Practice Address - Street 2:SUITE 4011
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2881
Practice Address - Country:US
Practice Address - Phone:903-893-0298
Practice Address - Fax:903-892-6323
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19902101YP2500X
TX34263103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200279950AMedicaid
TX180281104Medicaid
TX1802811-01Medicaid
614342Medicare PIN