Provider Demographics
NPI:1043087356
Name:VITEK, KRISTEN N (PHD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:VITEK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 9TH ST APT 1418
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2037
Mailing Address - Country:US
Mailing Address - Phone:708-856-2175
Mailing Address - Fax:
Practice Address - Street 1:120 9TH ST APT 1418
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2037
Practice Address - Country:US
Practice Address - Phone:708-856-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPSY-2023-0110103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical