Provider Demographics
NPI:1114552395
Name:BITTER, KENDREE BRINAE (MAS-LAMFT)
Entity Type:Individual
Prefix:MS
First Name:KENDREE
Middle Name:BRINAE
Last Name:BITTER
Suffix:
Gender:F
Credentials:MAS-LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 E VIA NICOLA
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-8917
Mailing Address - Country:US
Mailing Address - Phone:480-240-0342
Mailing Address - Fax:
Practice Address - Street 1:21455 S ELLSWORTH RD UNIT 44
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9849
Practice Address - Country:US
Practice Address - Phone:480-240-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-07
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10758106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ390200000XMedicaid