MEDICARE: WITT PSYCHOTHERAPY, PLLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1649952805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WITT PSYCHOTHERAPY, PLLC

Provider Business Mailing Address
First Line	:	2318 SAN PEDRO AVE STE 7
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-1901
Country	:	US
Telephone Number	:	210-660-8080
Fax Number	:	830-272-5032

Provider Business Practice Location Address
First Line	:	2318 SAN PEDRO AVE STE 7
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-1901
Country	:	US
Telephone Number	:	864-934-9893
Fax Number	:

Authorized Official
Title or Position	:	OWNER / SOLE MEMBER
Name	:	JUSTIN WITT
Credential	:	LCSW
Telephone Number	:	864-934-9893

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	12/10/2024

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