Provider Demographics
NPI:1629611447
Name:WITTE, ELLEN L
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:WITTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 WALDEN DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1196
Mailing Address - Country:US
Mailing Address - Phone:314-960-3173
Mailing Address - Fax:
Practice Address - Street 1:8 HILLTOP VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1105
Practice Address - Country:US
Practice Address - Phone:314-960-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health