Healthcare Provider Details

I. General information

NPI: 1457294639
Provider Name (Legal Business Name): KWHITLATCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 E BASELINE RD BLDG 2
GILBERT AZ
85234-2738
US

IV. Provider business mailing address

3303 E BASELINE RD BLDG 2
GILBERT AZ
85234-2738
US

V. Phone/Fax

Practice location:
  • Phone: 480-788-9816
  • Fax:
Mailing address:
  • Phone: 480-788-9816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KARISSA WHITLATCH
Title or Position: THERAPIST/OWNER
Credential: LPC
Phone: 909-262-6616