MEDICARE: MR. ANDREW DAVID KITZMILLER LPC-MHSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2494	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528393550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW DAVID KITZMILLER LPC-MHSP

Provider Business Mailing Address
First Line	:	1730 OLD GRAY STATION RD
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-3869
Country	:	US
Telephone Number	:	423-202-3008
Fax Number	:	423-202-7835

Provider Business Practice Location Address
First Line	:	2991 FORT HENRY DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-4005
Country	:	US
Telephone Number	:	423-392-2975
Fax Number	:	423-392-2983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	02/12/2026

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