MEDICARE: MRS. KEEAYLA S WILHITE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	107540	TX

General Provider Information

NPI Number	:	1063218113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEEAYLA S WILHITE LCSW

Provider Business Mailing Address
First Line	:	110 N AKARD ST # 1035
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-3503
Country	:	US
Telephone Number	:	773-240-0654
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 N AKARD ST # 1035
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-3503
Country	:	US
Telephone Number	:	773-240-0654
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2025
Last Update Date	:	06/20/2026

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