Provider Demographics
NPI:1386725687
Name:GRITZMACHER, STEVEN ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALAN
Last Name:GRITZMACHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 S BRADFORD AVE
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7122
Mailing Address - Country:US
Mailing Address - Phone:417-724-2839
Mailing Address - Fax:417-725-8983
Practice Address - Street 1:214 VILLAGE CENTER ST
Practice Address - Street 2:B
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8869
Practice Address - Country:US
Practice Address - Phone:417-725-8922
Practice Address - Fax:417-725-8983
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical