Provider Demographics
NPI:1639190168
Name:WITTE, LILLIAN KAY (LPC)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:KAY
Last Name:WITTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 E 12TH ST
Mailing Address - Street 2:APT. 222
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3153
Mailing Address - Country:US
Mailing Address - Phone:307-262-7789
Mailing Address - Fax:
Practice Address - Street 1:1430 WILKINS CIR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1336
Practice Address - Country:US
Practice Address - Phone:307-237-9583
Practice Address - Fax:307-265-7277
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health