Provider Demographics
NPI:1881940237
Name:PITCOCK, RICHARD (LSPE)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PITCOCK
Suffix:
Gender:M
Credentials:LSPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 RANDY RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-2815
Mailing Address - Country:US
Mailing Address - Phone:615-200-2538
Mailing Address - Fax:615-746-1423
Practice Address - Street 1:1417 RANDY RD
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-2815
Practice Address - Country:US
Practice Address - Phone:615-200-2538
Practice Address - Fax:615-746-5013
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE0000011351103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent