Provider Demographics
NPI:1205049129
Name:WITT, KEVIN H
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:H
Last Name:WITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 S STATE HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5918
Mailing Address - Country:US
Mailing Address - Phone:214-783-1242
Mailing Address - Fax:
Practice Address - Street 1:1531 S STATE HIGHWAY 121
Practice Address - Street 2:APT. 1710
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-5918
Practice Address - Country:US
Practice Address - Phone:214-783-1242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health