Provider Demographics
NPI:1154431377
Name:PICKETT, HAROLD WILLIAM JR (PSYD LP)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:WILLIAM
Last Name:PICKETT
Suffix:JR
Gender:M
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 DECATUR AVE N
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4367
Mailing Address - Country:US
Mailing Address - Phone:763-746-2400
Mailing Address - Fax:763-462-2401
Practice Address - Street 1:701 DECATUR AVE N
Practice Address - Street 2:SUITE 109
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4367
Practice Address - Country:US
Practice Address - Phone:763-746-2400
Practice Address - Fax:763-462-2401
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 3575103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN122401OtherUCARE
MN6169015OtherUBH
MN999213100Medicaid
MN2004302OtherBHP
MN6C364PIOtherBCBS