Provider Demographics
NPI:1902464068
Name:TTITTEL, KATHLEEN M
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:TTITTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1969 SAN VINCENTE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-1016
Mailing Address - Country:US
Mailing Address - Phone:928-890-6514
Mailing Address - Fax:
Practice Address - Street 1:2975 TREAT BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3601
Practice Address - Country:US
Practice Address - Phone:928-691-5083
Practice Address - Fax:925-691-5369
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)