Provider Demographics
NPI:1891046447
Name:PICKETT, SCOTT MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:PICKETT
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 1:1202 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-5712
Mailing Address - Country:US
Mailing Address - Phone:810-957-1319
Mailing Address - Fax:
Practice Address - Street 1:1202 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-5712
Practice Address - Country:US
Practice Address - Phone:810-957-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-23
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013971103TC0700X
FLPY11000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical