Basic Information
Provider Information
NPI: 1851375299
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FITTS
FirstName: DONALD
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: DMIN, LMFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 501 ALBANY AVE
Address2:  
City: TORRINGTON
State: WY
PostalCode: 822401503
CountryCode: US
TelephoneNumber: 3075324091
FaxNumber: 3075328409
Practice Location
Address1: 501 ALBANY AVE
Address2:  
City: TORRINGTON
State: WY
PostalCode: 822401503
CountryCode: US
TelephoneNumber: 3075324091
FaxNumber: 3075328409
Other Information
ProviderEnumerationDate: 11/30/2005
LastUpdateDate: 03/16/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X108WYY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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