Basic Information
Provider Information
NPI: 1366543241
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HITT
FirstName: SABRINA
MiddleName: KELLEY
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3601 S 6TH AVE
Address2: MENTAL HEALTH CLINIC, 4-116A
City: TUCSON
State: AZ
PostalCode: 857230001
CountryCode: US
TelephoneNumber: 5207921450
FaxNumber:  
Practice Location
Address1: 3601 S 6TH AVE
Address2: MENTAL HEALTH CLINIC, 4-116A
City: TUCSON
State: AZ
PostalCode: 857230001
CountryCode: US
TelephoneNumber: 5207921450
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/25/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X3502AZY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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