Provider Demographics
NPI:1467454645
Name:DR. GARY C. KITTO AND ASSOCIATES
Entity Type:Organization
Organization Name:DR. GARY C. KITTO AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KITTO
Authorized Official - Suffix:
Authorized Official - Credentials:PH D MS
Authorized Official - Phone:660-826-7909
Mailing Address - Street 1:100 S LIMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-3655
Mailing Address - Country:US
Mailing Address - Phone:660-826-7909
Mailing Address - Fax:660-826-6737
Practice Address - Street 1:100 S LIMIT AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-3655
Practice Address - Country:US
Practice Address - Phone:660-826-7909
Practice Address - Fax:660-826-6737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO22580011OtherBLUE CROSS / BLUE SHIELD
MO22580011OtherBLUE CROSS / BLUE SHIELD