Provider Demographics
NPI:1649532714
Name:LITWIN, TRACEY E (PSYD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:E
Last Name:LITWIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 W. 107TH ST.
Mailing Address - Street 2:SUITE 11
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212
Mailing Address - Country:US
Mailing Address - Phone:913-735-0454
Mailing Address - Fax:913-677-3282
Practice Address - Street 1:7180 W. 107TH ST.
Practice Address - Street 2:SUITE 11
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212
Practice Address - Country:US
Practice Address - Phone:913-735-0454
Practice Address - Fax:913-677-3282
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1770103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201090530AMedicaid