Provider Demographics
NPI:1245673409
Name:PITTMAN, KATHRYN JEANETTE (LMFT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JEANETTE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-0091
Mailing Address - Country:US
Mailing Address - Phone:620-391-1154
Mailing Address - Fax:
Practice Address - Street 1:606 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HUGOTON
Practice Address - State:KS
Practice Address - Zip Code:67951-2429
Practice Address - Country:US
Practice Address - Phone:620-391-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2459106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist