Provider Demographics
NPI:1760261887
Name:JETER, KAITLIN SUZANNE (LAMFT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:SUZANNE
Last Name:JETER
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14535 W INDIAN SCHOOL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9282
Mailing Address - Country:US
Mailing Address - Phone:623-335-2290
Mailing Address - Fax:
Practice Address - Street 1:14535 W INDIAN SCHOOL RD STE 120
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9282
Practice Address - Country:US
Practice Address - Phone:623-335-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-08008T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist