Provider Demographics
NPI:1629360060
Name:WITT, MARY ANGELA (MMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELA
Last Name:WITT
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 VALLEYWOOD CV
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0871
Mailing Address - Country:US
Mailing Address - Phone:615-867-8303
Mailing Address - Fax:
Practice Address - Street 1:2670 MEMORIAL BLVD STE E1
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5134
Practice Address - Country:US
Practice Address - Phone:615-890-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist