Provider Demographics
NPI:1710205117
Name:WHITWORTH, KAYLA RENAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:RENAE
Last Name:WHITWORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 S CORINTH ST APT 4202
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-3706
Mailing Address - Country:US
Mailing Address - Phone:940-453-1559
Mailing Address - Fax:
Practice Address - Street 1:2305 DEL MAR CT
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-3639
Practice Address - Country:US
Practice Address - Phone:940-453-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX501401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341219901Medicaid
TX375899YSK0Medicare PIN