Provider Demographics
NPI:1144341942
Name:PITRE, NICOLE D (MS, LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:PITRE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3924
Mailing Address - Country:US
Mailing Address - Phone:405-799-3379
Mailing Address - Fax:
Practice Address - Street 1:554 MALLARD LN
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-7182
Practice Address - Country:US
Practice Address - Phone:405-390-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health