Healthcare Provider Details

I. General information

NPI: 1376437764
Provider Name (Legal Business Name): KATIE WESTFALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 US HIGHWAY 17 STE 103
FLEMING ISLAND FL
32003-4832
US

IV. Provider business mailing address

4375 US HIGHWAY 17 STE 103
FLEMING ISLAND FL
32003-4832
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-0886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: