Individual
KAELA GRACE WHITEHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2022 E CHALLIS DR, MERIDIAN, ID 83646-7370
(714) 261-0302
Mailing address
2022 E CHALLIS DR, MERIDIAN, ID 83646-7370
(208) 649-4203
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LMSW36309
ID
1041C0700X
Clinical Social Worker
Primary
LCSW38786
ID
Other
Enumeration date
01/06/2017
Last updated
12/19/2023
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