Provider Demographics
NPI:1669601266
Name:PITTS, CORNELIUS (MCP, LPC)
Entity type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:
Last Name:PITTS
Suffix:
Gender:M
Credentials:MCP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-4027
Mailing Address - Country:US
Mailing Address - Phone:580-234-8865
Mailing Address - Fax:580-234-8361
Practice Address - Street 1:119 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4027
Practice Address - Country:US
Practice Address - Phone:580-234-8865
Practice Address - Fax:580-234-8361
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health