Provider Demographics
NPI:1609225036
Name:WITTMAN, THERESA (MS)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:WITTMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:THERESA
Other - Last Name:WITTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6651 MAIN ST
Mailing Address - Street 2:SUITE F450
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6651 MAIN ST
Practice Address - Street 2:SUITE F450
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2351
Practice Address - Country:US
Practice Address - Phone:505-234-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS