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General NPI Number Information
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NPI Number | 1669015178
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Entity Type | Individual
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Provider Name | STEPHANIE WITT MA
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Gender | Female
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 758 W WILDRYE CT
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City | NAMPA
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State | ID
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Zip | 83686-4919
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Country | US
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Telephone | 208-992-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 758 W WILDRYE CT
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City | NAMPA
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State | ID
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Zip | 83686-4919
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Country | US
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Telephone | 253-279-6886
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-7417
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-9166
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License Number State | ID
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