Provider Demographics
NPI:1376793067
Name:WITTE-HUBBARD, KRISTIN NICOLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NICOLE
Last Name:WITTE-HUBBARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GRUENE PARK DR.
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2459
Mailing Address - Country:US
Mailing Address - Phone:830-625-0599
Mailing Address - Fax:830-625-5877
Practice Address - Street 1:43 GRUENE PARK DR.
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2459
Practice Address - Country:US
Practice Address - Phone:830-625-0599
Practice Address - Fax:830-625-5877
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60872101YP2500X
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199102802Medicaid