Provider Demographics
NPI:1578013710
Name:WITMAN, JODY (MA MHP LMHC)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:
Last Name:WITMAN
Suffix:
Gender:F
Credentials:MA MHP LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 W REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-4554
Mailing Address - Country:US
Mailing Address - Phone:360-330-9044
Mailing Address - Fax:360-736-3139
Practice Address - Street 1:1402 BROADWAY ST STE 106
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3714
Practice Address - Country:US
Practice Address - Phone:360-481-2866
Practice Address - Fax:360-481-2866
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
WALH60953713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health