Healthcare Provider Details

I. General information

NPI: 1972390573
Provider Name (Legal Business Name): KE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4116 SAYLOR LN UNIT B
CALDWELL ID
83607-1096
US

IV. Provider business mailing address

4116 SAYLOR LN UNIT B
CALDWELL ID
83607-1096
US

V. Phone/Fax

Practice location:
  • Phone: 435-572-0340
  • Fax:
Mailing address:
  • Phone: 435-572-0340
  • 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: KHADIJA TAHIRA EWALT
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 435-572-0340