MEDICARE: LILLIAN KAY WITTE LPC

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	101YM0800X	Mental Health Counselor	LPC-925	WY

General Provider Information

NPI Number	:	1639190168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN KAY WITTE LPC

Provider Business Mailing Address
First Line	:	3900 E 12TH ST
Second Line	:	APT. 222
City	:	CASPER
State	:	WY
Zip	:	82609-3153
Country	:	US
Telephone Number	:	307-262-7789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 WILKINS CIR
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-1336
Country	:	US
Telephone Number	:	307-237-9583
Fax Number	:	307-265-7277

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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