MEDICARE: KIMBERLEY WITTER AMFT

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1457051716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY WITTER AMFT

Provider Business Mailing Address
First Line	:	1173 S 250 W STE 208
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84770-6747
Country	:	US
Telephone Number	:	435-688-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 FALCON RIDGE PKWY STE 402
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-8879
Country	:	US
Telephone Number	:	435-688-1111
Fax Number	:

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

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	03/06/2023

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Directions to “ KIMBERLEY WITTER AMFT” Practice Location

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