Provider Demographics
NPI:1184174948
Name:WOOLSTENHULME, KENDRA (LCMFT)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:
Last Name:WOOLSTENHULME
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6796
Mailing Address - Country:US
Mailing Address - Phone:202-681-2277
Mailing Address - Fax:
Practice Address - Street 1:3401 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6796
Practice Address - Country:US
Practice Address - Phone:202-681-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM613106H00000X
MDLCM778106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist