Provider Demographics
NPI:1770989121
Name:PITSAVAS, NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:PITSAVAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W MEEKER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4323
Mailing Address - Country:US
Mailing Address - Phone:206-764-8019
Mailing Address - Fax:
Practice Address - Street 1:1601 W MEEKER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4323
Practice Address - Country:US
Practice Address - Phone:206-764-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist