Provider Demographics
NPI:1588132864
Name:PICKETT PSYCHOLOGICAL INC.
Entity type:Organization
Organization Name:PICKETT PSYCHOLOGICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-333-1086
Mailing Address - Street 1:3970 NOBEL DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5796
Mailing Address - Country:US
Mailing Address - Phone:858-333-1086
Mailing Address - Fax:
Practice Address - Street 1:7825 FAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4270
Practice Address - Country:US
Practice Address - Phone:858-333-1086
Practice Address - Fax:858-332-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty