| Doctor Name: | MS. NISY ITTY |
| NPI Number: | 1104188655 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.H.S, CRC |
| License Number: | 00111018 |
| Business Practice Address: | 315 N Lakemont Ave Suite B Winter Park, FL - 327923205 |
| Business Phone Number: | 4078306412 |
| Business Fax Number: | 4078308413 |
| Mailing Address: | 453 Bridge Creek Blvd, OCOEE |
| State: | FL |
| Postal Code: | 347614726 |
| Phone Number: | 3212173641 |
| Fax Number: | |
| NPI Enumeration Date: | 06/11/2012 |
| NPI Last Update Date: | 06/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 00111018 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |