MEDICARE: KOLLETTE WHITLEY LPC

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	101YP2500X	Professional Counselor	73165	TX
2	101YP2500X	Professional Counselor	74488	TX

General Provider Information

NPI Number	:	1215448980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOLLETTE WHITLEY LPC

Provider Business Mailing Address
First Line	:	PO BOX 417
Second Line	:
City	:	GANADO
State	:	TX
Zip	:	77962-0417
Country	:	US
Telephone Number	:	361-491-1443
Fax Number	:

Provider Business Practice Location Address
First Line	:	17350 STATE HIGHWAY 249 STE 220-6454
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1147
Country	:	US
Telephone Number	:	361-238-7355
Fax Number	:

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

Provider Enumeration Date	:	10/20/2017
Last Update Date	:	11/30/2023

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Directions to “ KOLLETTE WHITLEY LPC” Practice Location

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