Provider Demographics
NPI:1164008348
Name:JUDD, KAELA (AMFT)
Entity Type:Individual
Prefix:
First Name:KAELA
Middle Name:
Last Name:JUDD
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N MALL DR STE M202
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7316
Mailing Address - Country:US
Mailing Address - Phone:502-294-9814
Mailing Address - Fax:
Practice Address - Street 1:321 N MALL DR STE M202
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7316
Practice Address - Country:US
Practice Address - Phone:502-294-9814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12090531-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist