Doctor Name: | MR. DENNIS DALE WHITTEN |
NPI Number: | 1184743502 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MACJ, LADC, ICAADC |
License Number: | 72 |
Business Practice Address: | 104 N.e. Avenue A Idabel, OK - 74745 |
Business Phone Number: | 5802129175 |
Business Fax Number: | 5802866385 |
Mailing Address: | Po Box 555, IDABEL |
State: | OK |
Postal Code: | 747450555 |
Phone Number: | 5802129175 |
Fax Number: | 5802866385 |
NPI Enumeration Date: | 03/28/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 72 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |