Provider Demographics
NPI:1841483377
Name:KITTERMAN, MINDY S (LSCSW)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:S
Last Name:KITTERMAN
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 N ANNE SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6790
Mailing Address - Country:US
Mailing Address - Phone:913-904-2893
Mailing Address - Fax:
Practice Address - Street 1:8787 BALLENTINE, SUITE 1200
Practice Address - Street 2:MILL CREEK OUTPATIENT SERVICES
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-1979
Practice Address - Country:US
Practice Address - Phone:913-339-9933
Practice Address - Fax:913-339-9915
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 20100333531041C0700X
KSLCAC 133101YA0400X
KSLSCSW 15751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)