Provider Demographics
NPI:1114954062
Name:KITTRELL, ROBYN (PHD HSPP)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:KITTRELL
Suffix:
Gender:F
Credentials:PHD HSPP
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:
Other - Last Name:PALSROK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD HSPP
Mailing Address - Street 1:1904 WEST ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2264
Mailing Address - Country:US
Mailing Address - Phone:765-284-0043
Mailing Address - Fax:765-284-4112
Practice Address - Street 1:1904 WEST ROYALE DRIVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2264
Practice Address - Country:US
Practice Address - Phone:765-284-0443
Practice Address - Fax:765-284-4112
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041894A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000030791OtherMPLAN
IN000000363649OtherANTHEM BCBS
IN740327000OtherMAGELLAN HEALTH SERVICES