Provider Demographics
NPI:1275183626
Name:PITZER, KRISTEN BETH
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:BETH
Last Name:PITZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 HEATHER RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705
Mailing Address - Country:US
Mailing Address - Phone:315-396-6226
Mailing Address - Fax:
Practice Address - Street 1:4500 W ILLINOIS AVE
Practice Address - Street 2:STE 310 E
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703
Practice Address - Country:US
Practice Address - Phone:432-214-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional