Healthcare Provider Details

I. General information

NPI: 1528393550
Provider Name (Legal Business Name): ANDREW DAVID KITZMILLER LPC-MHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 OLD GRAY STATION RD
JOHNSON CITY TN
37615-3869
US

IV. Provider business mailing address

1730 OLD GRAY STATION RD
JOHNSON CITY TN
37615-3869
US

V. Phone/Fax

Practice location:
  • Phone: 423-202-3008
  • Fax: 423-202-7835
Mailing address:
  • Phone: 423-202-3008
  • Fax: 423-202-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2494
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: