Provider Demographics
NPI:1194499913
Name:PICKARD, JOSEPH G (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:PICKARD
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 STAVE MILL RD
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-4888
Mailing Address - Country:US
Mailing Address - Phone:314-580-4791
Mailing Address - Fax:
Practice Address - Street 1:411 STAVE MILL RD
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-4888
Practice Address - Country:US
Practice Address - Phone:314-580-4791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010297121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical