Provider Demographics
NPI:1447069620
Name:WITTUM PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:WITTUM PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:270-465-0227
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42719-0335
Mailing Address - Country:US
Mailing Address - Phone:703-300-2350
Mailing Address - Fax:
Practice Address - Street 1:408 HOTCHKISS ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1340
Practice Address - Country:US
Practice Address - Phone:270-465-0227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty