Provider Demographics
NPI:1851651921
Name:WITEK, KRISTEN NELL (LMFT91337)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NELL
Last Name:WITEK
Suffix:
Gender:F
Credentials:LMFT91337
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5424
Mailing Address - Country:US
Mailing Address - Phone:760-842-6261
Mailing Address - Fax:760-726-6102
Practice Address - Street 1:200 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5424
Practice Address - Country:US
Practice Address - Phone:760-842-6261
Practice Address - Fax:760-726-6102
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 69272106H00000X
CALMFT91337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist