Doctor Name: | JASON WHITED |
NPI Number: | 1033290143 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPCC |
License Number: | 321 |
Business Practice Address: | 390 Keen Street Burkesville, KY - 42717 |
Business Phone Number: | 2708645631 |
Business Fax Number: | 2708642239 |
Mailing Address: | 259 Parkers Mill Rd, SOMERSET |
State: | KY |
Postal Code: | 425013152 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 321 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |