Provider Demographics
NPI:1457810202
Name:PITTS, WILLLIAM LEE (BA)
Entity type:Individual
Prefix:
First Name:WILLLIAM
Middle Name:LEE
Last Name:PITTS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:LEE
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-0689
Mailing Address - Country:US
Mailing Address - Phone:580-286-3301
Mailing Address - Fax:
Practice Address - Street 1:104 NE AVE A
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-3813
Practice Address - Country:US
Practice Address - Phone:580-286-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)