Provider Demographics
NPI:1588179907
Name:WHITEAKER, KELLI LYNN (LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:LYNN
Last Name:WHITEAKER
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32650 STATE ROUTE 20 STE 203
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2641
Mailing Address - Country:US
Mailing Address - Phone:360-682-6499
Mailing Address - Fax:360-628-6367
Practice Address - Street 1:32650 STATE ROUTE 20 STE 203
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2641
Practice Address - Country:US
Practice Address - Phone:360-682-6499
Practice Address - Fax:360-682-6367
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60816333106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty