MEDICARE: DR. KITTI L VIRTS PHD

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	103TC0700X	Clinical Psychologist	2207	TN

General Provider Information

NPI Number	:	1871681486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KITTI L VIRTS PHD

Provider Business Mailing Address
First Line	:	614 BARLIN DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-3443
Country	:	US
Telephone Number	:	615-646-1450
Fax Number	:	615-322-1578

Provider Business Practice Location Address
First Line	:	108 HARDING PL
Second Line	:	SUITE 200C
City	:	NASHVILLE
State	:	TN
Zip	:	37205-3704
Country	:	US
Telephone Number	:	615-848-8214
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/09/2007

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