Provider Demographics
NPI:1699832824
Name:KITTRELL, ELIZABETH MARIE PAGEL (MA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE PAGEL
Last Name:KITTRELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 W OAK ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2875
Mailing Address - Country:US
Mailing Address - Phone:970-494-0210
Mailing Address - Fax:970-494-0210
Practice Address - Street 1:149 W OAK ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2875
Practice Address - Country:US
Practice Address - Phone:970-494-0210
Practice Address - Fax:970-494-0210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9908051Medicaid
CO667976OtherANTHEM INSURANCE ID NUMBE
CO492580OtherVALUEOPTIONS INSURANCE ID