Individual
KALEB SHANE WHITWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCA
Contact information
Practice address
736 WHITE RD, PORTLAND, TN 37148-5040
(615) 516-1610
Mailing address
736 WHITE RD, PORTLAND, TN 37148-5040
(615) 516-1610
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
246270
—
Other
Enumeration date
05/20/2021
Last updated
05/20/2021
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