Provider Demographics
NPI:1932403821
Name:PICKENS, HAROLD LEON (MA)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:LEON
Last Name:PICKENS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7136
Mailing Address - Country:US
Mailing Address - Phone:541-779-2393
Mailing Address - Fax:541-779-3317
Practice Address - Street 1:695 MISTLETOE RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9552
Practice Address - Country:US
Practice Address - Phone:541-482-8906
Practice Address - Fax:541-482-6462
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor