Provider Demographics
NPI:1134430150
Name:STITT, KERI MARIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:MARIE
Last Name:STITT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 N ZANG BLVD
Mailing Address - Street 2:1212
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1202
Mailing Address - Country:US
Mailing Address - Phone:972-746-6381
Mailing Address - Fax:
Practice Address - Street 1:224 W PAGE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6631
Practice Address - Country:US
Practice Address - Phone:214-941-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64237101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional