Provider Demographics
NPI:1912005638
Name:WITTY, STEPHEN (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:WITTY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13996 W COUNTY ROAD 270
Mailing Address - Street 2:
Mailing Address - City:NATHROP
Mailing Address - State:CO
Mailing Address - Zip Code:81236-9749
Mailing Address - Country:US
Mailing Address - Phone:719-471-7837
Mailing Address - Fax:719-471-7845
Practice Address - Street 1:525 N NEVADA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4936
Practice Address - Country:US
Practice Address - Phone:719-471-7837
Practice Address - Fax:719-471-7845
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO161655573103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist