Provider Demographics
NPI:1447509021
Name:PITTMAN, ANNIE LEE
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:LEE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 BRANDENBURG LANE
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2036
Mailing Address - Country:US
Mailing Address - Phone:972-625-0990
Mailing Address - Fax:972-350-9573
Practice Address - Street 1:4800 BRANDENBURG LANE
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2036
Practice Address - Country:US
Practice Address - Phone:972-625-0990
Practice Address - Fax:972-350-9573
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18351101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional