Provider Demographics
NPI:1922383306
Name:STITH, SANDRA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:STITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CAMPUS CREEK COMPLEX
Mailing Address - Street 2:KSU FAMILY CENTER
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66506
Mailing Address - Country:US
Mailing Address - Phone:785-532-6984
Mailing Address - Fax:785-532-6523
Practice Address - Street 1:139 CAMPUS CREEK COMPLEX
Practice Address - Street 2:KSU FAMILY CENTER
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66506
Practice Address - Country:US
Practice Address - Phone:785-532-6984
Practice Address - Fax:785-532-6523
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS676106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist