Basic Information
| Provider Information | |||||||||
| NPI: | 1629195359 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PITTS | ||||||||
| FirstName: | MILTON | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 CANDLE PINE PL # 100 | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773816436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007467284 | ||||||||
| FaxNumber: | 9362733786 | ||||||||
| Practice Location | |||||||||
| Address1: | 5100 RANDOL MILL RD | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761121553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174518001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 11184 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | P00017129 | 01 | TX | RAILROAD MEDICARE | OTHER |