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General NPI Number Information
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NPI Number | 1487091682
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Entity Type | Individual
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Provider Name | JEANNE PATRICIA WITTER PHD, LPC, LISAC
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Gender | Female
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 17505 N 79TH AVE SUITE 410D
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City | GLENDALE
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State | AZ
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Zip | 85308-8725
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Country | US
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Telephone | 623-340-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 13839 N DRIFTWOOD PT
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City | SUN CITY
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State | AZ
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Zip | 85351-2309
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Country | US
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Telephone | 623-340-1020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC-11849
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-12942
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License Number State | AZ
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