Doctor Name: | AUTUMN WHITAKER |
NPI Number: | 1619142767 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 604 Choctaw Northwest Center For Behavioral Health Alva, OK - 73717 |
Business Phone Number: | 5803271112 |
Business Fax Number: | 5803273067 |
Mailing Address: | 1222 10th Street, Suite 211, Northwest Center For Behavioral Health WOODWARD |
State: | OK |
Postal Code: | 73801 |
Phone Number: | 5803271112 |
Fax Number: | 5803273067 |
NPI Enumeration Date: | 04/29/2008 |
NPI Last Update Date: | 11/30/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |