Provider Demographics
NPI:1790969293
Name:KITZMILLER, ELIZABETH ANNE (PHD, LPC-MHSP,LMFT)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:KITZMILLER
Suffix:
Gender:F
Credentials:PHD, LPC-MHSP,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E MAIN ST STE 210B
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4257
Mailing Address - Country:US
Mailing Address - Phone:423-530-7042
Mailing Address - Fax:
Practice Address - Street 1:108 E MAIN ST STE 210B
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4257
Practice Address - Country:US
Practice Address - Phone:423-530-7042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2220101YM0800X, 101YP2500X
LA1088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional