Provider Demographics
NPI:1942928825
Name:PERMSOOKJIT, SITTIPONG (PHD)
Entity Type:Individual
Prefix:DR
First Name:SITTIPONG
Middle Name:
Last Name:PERMSOOKJIT
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 1:601 UNIVERSITY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2168
Mailing Address - Country:US
Mailing Address - Phone:682-312-9820
Mailing Address - Fax:682-312-9821
Practice Address - Street 1:601 UNIVERSITY DR STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2168
Practice Address - Country:US
Practice Address - Phone:682-312-9820
Practice Address - Fax:682-312-9821
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39539103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39539OtherLP