Provider Demographics
NPI:1194129387
Name:PITSELOS, JOHN G (CAP, CMHP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:PITSELOS
Suffix:
Gender:M
Credentials:CAP, CMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 FOX ROAD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD FLORIDA
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135 FOX ROAD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD FLORIDA
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-342-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst