Provider Demographics
NPI:1073642526
Name:WHITAKER, KEITH DAVIDSON (LMFT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DAVIDSON
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 5412
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-9530
Mailing Address - Country:US
Mailing Address - Phone:808-982-6503
Mailing Address - Fax:808-982-6298
Practice Address - Street 1:HC 1 BOX 5412
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-9530
Practice Address - Country:US
Practice Address - Phone:808-982-6503
Practice Address - Fax:808-982-6298
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI26106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist