Provider Demographics
NPI:1174681043
Name:WHITTAKER, KAREN MELIZA (MS)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MELIZA
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELAINE
Other - Last Name:WHITTAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17 12TH AVENUE SO
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83681
Mailing Address - Country:US
Mailing Address - Phone:208-463-9450
Mailing Address - Fax:208-465-9072
Practice Address - Street 1:17 12TH AVENUE SO
Practice Address - Street 2:SUITE 204
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83681
Practice Address - Country:US
Practice Address - Phone:208-463-9450
Practice Address - Fax:208-465-9072
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 301101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor