Provider Demographics
NPI:1669464186
Name:FISHER-KITTAY, LYNN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:E
Last Name:FISHER-KITTAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 S STAPLES ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4682
Mailing Address - Country:US
Mailing Address - Phone:361-992-3388
Mailing Address - Fax:361-992-3355
Practice Address - Street 1:5350 S STAPLES ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4682
Practice Address - Country:US
Practice Address - Phone:361-992-3388
Practice Address - Fax:361-992-3355
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24961103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035658601Medicaid
TXR62466Medicare UPIN
TX035658601Medicaid