Provider Demographics
NPI:1972695294
Name:PITTS, DONALD CICERO (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CICERO
Last Name:PITTS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 N BELLAIRE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2077
Mailing Address - Country:US
Mailing Address - Phone:502-379-5242
Mailing Address - Fax:
Practice Address - Street 1:703 S 31ST ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1410
Practice Address - Country:US
Practice Address - Phone:502-776-4200
Practice Address - Fax:502-776-4280
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0150106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist