Provider Demographics
NPI:1649952805
Name:WITT PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:WITT PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:864-934-9893
Mailing Address - Street 1:2318 SAN PEDRO AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1901
Mailing Address - Country:US
Mailing Address - Phone:210-660-8080
Mailing Address - Fax:830-272-5032
Practice Address - Street 1:2318 SAN PEDRO AVE STE 7
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1901
Practice Address - Country:US
Practice Address - Phone:864-934-9893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health