Provider Demographics
NPI:1881097806
Name:PITOT, MARY MICHELLE (EDD, LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MICHELLE
Last Name:PITOT
Suffix:
Gender:F
Credentials:EDD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5181 N CALLE BUJIA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6167
Mailing Address - Country:US
Mailing Address - Phone:520-440-8791
Mailing Address - Fax:
Practice Address - Street 1:5181 N CALLE BUJIA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6167
Practice Address - Country:US
Practice Address - Phone:520-440-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-04
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW4110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health