Provider Demographics
NPI:1942348669
Name:WITTE, AMY LISA (MFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LISA
Last Name:WITTE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 FAIR OAKS BLVD
Mailing Address - Street 2:SU. G-H
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7079
Mailing Address - Country:US
Mailing Address - Phone:916-837-1759
Mailing Address - Fax:916-962-1940
Practice Address - Street 1:9700 FAIR OAKS BLVD
Practice Address - Street 2:SU. G-H
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7079
Practice Address - Country:US
Practice Address - Phone:916-837-1759
Practice Address - Fax:916-962-1940
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist