Provider Demographics
NPI:1760351852
Name:PITTMAN, GRAYSON LAYNE
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:LAYNE
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 1:833 N BECKLEY AVE APT 2205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1606
Mailing Address - Country:US
Mailing Address - Phone:469-218-5966
Mailing Address - Fax:
Practice Address - Street 1:9330 LYNDON B JOHNSON FWY STE 1250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3436
Practice Address - Country:US
Practice Address - Phone:469-218-5966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-05
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist