Provider Demographics
NPI:1790406650
Name:KITNEY, MICHELE (MA, LPC-A)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:KITNEY
Suffix:
Gender:F
Credentials:MA, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 CHOCTAW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7434
Mailing Address - Country:US
Mailing Address - Phone:414-379-8677
Mailing Address - Fax:
Practice Address - Street 1:2005 CHOCTAW RIDGE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-7434
Practice Address - Country:US
Practice Address - Phone:414-379-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty