Healthcare Provider Details

I. General information

NPI: 1114954062
Provider Name (Legal Business Name): ROBYN KITTRELL PHD HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBYN PALSROK PHD HSPP

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 WEST ROYALE DRIVE
MUNCIE IN
47304-2264
US

IV. Provider business mailing address

1904 WEST ROYALE DR
MUNCIE IN
47304-2264
US

V. Phone/Fax

Practice location:
  • Phone: 765-284-0443
  • Fax: 765-284-4112
Mailing address:
  • Phone: 765-284-0043
  • Fax: 765-284-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20041894A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: