Provider Demographics
NPI:1427125103
Name:PICKETT, PATT HOLLINGER (PHD)
Entity type:Individual
Prefix:DR
First Name:PATT
Middle Name:HOLLINGER
Last Name:PICKETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PATT
Other - Middle Name:ANN
Other - Last Name:PICKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1000 LAKE ST LOUIS BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367
Mailing Address - Country:US
Mailing Address - Phone:636-561-8839
Mailing Address - Fax:636-561-5042
Practice Address - Street 1:1000 LAKE ST LOUIS BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367
Practice Address - Country:US
Practice Address - Phone:636-561-8839
Practice Address - Fax:636-561-5042
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLMFT000030106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist