=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902237530
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE MUTHONI KITHINJI P.HD.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2013
-----------------------------------------------------
Last Update Date | 12/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 KS HIGHWAY 264
-----------------------------------------------------
City | LARNED
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67550-5353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-285-4836
-----------------------------------------------------
Fax | 620-285-4509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 HILLCREST DR
-----------------------------------------------------
City | LARNED
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67550-4001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-514-8954
-----------------------------------------------------
Fax | 620-285-4509
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | T-LP 2187
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------