MEDICARE: TRICIA WITTE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1378	AL

General Provider Information

NPI Number	:	1013520204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA WITTE PHD

Provider Business Mailing Address
First Line	:	4405 WOODLAND HILLS DR
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35405-5420
Country	:	US
Telephone Number	:	205-266-3425
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 WOODLAND HILLS DR
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35405-5420
Country	:	US
Telephone Number	:	205-266-3425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	08/26/2020

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