Individual
TERRELL DONNELL PICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
22490 N VANDERVEEN WAY, MARICOPA, AZ 85138-5569
(623) 826-4195
(602) 279-1431
Mailing address
PO BOX 16906, PHOENIX, AZ 85011-6906
(602) 279-1427
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
103TE1100X
Exercise & Sports Psychologist
—
—
103TF0000X
Family Psychologist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6426468
DCS/OLR
AZ
Enumeration date
08/24/2017
Last updated
02/06/2025
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