| Doctor Name: | MR. TADD MICHAEL WHALLON |
| NPI Number: | 1376807370 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCAC |
| License Number: | 87000325A |
| Business Practice Address: | 515 N Green St Ste 402 Brownsburg, IN - 461122421 |
| Business Phone Number: | 3178523690 |
| Business Fax Number: | |
| Mailing Address: | 10889 Parker Dr, INDIANAPOLIS |
| State: | IN |
| Postal Code: | 462311077 |
| Phone Number: | 3173130448 |
| Fax Number: | |
| NPI Enumeration Date: | 06/25/2012 |
| NPI Last Update Date: | 06/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 87000325A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |