Provider Demographics
NPI:1225560071
Name:WILHITE, KELLYE (MED, LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:KELLYE
Middle Name:
Last Name:WILHITE
Suffix:
Gender:F
Credentials:MED, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 IRONTON AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4102
Mailing Address - Country:US
Mailing Address - Phone:806-441-8823
Mailing Address - Fax:
Practice Address - Street 1:410 IRONTON AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4102
Practice Address - Country:US
Practice Address - Phone:806-441-8823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73937101Y00000X
TX13441101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)