Provider Demographics
NPI:1558071233
Name:ZITTING, LEVI DAUNT
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:DAUNT
Last Name:ZITTING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:ID
Mailing Address - Zip Code:83429-0131
Mailing Address - Country:US
Mailing Address - Phone:385-244-0588
Mailing Address - Fax:866-936-2188
Practice Address - Street 1:740 N HAMMON ST # 2056
Practice Address - Street 2:
Practice Address - City:HILDALE
Practice Address - State:UT
Practice Address - Zip Code:84784-7794
Practice Address - Country:US
Practice Address - Phone:435-212-3108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10074703-2506103K00000X
UT10074703-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst