1639224462 NPI number — MR. LLOYD WAYNE WHYTE MSW LCSW MO LICENSE

Table of content: MR. LLOYD WAYNE WHYTE MSW LCSW MO LICENSE (NPI 1639224462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639224462 NPI number — MR. LLOYD WAYNE WHYTE MSW LCSW MO LICENSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHYTE
Provider First Name:
LLOYD
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW MO LICENSE
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639224462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4304 SAVANNAH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65202-4250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-446-0849
Provider Business Mailing Address Fax Number:
573-446-0849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4304 SAVANNAH CT
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65202-4250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-446-0849
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  MO001674 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 493238902 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 737320 . This is a "WELLCARE/MOCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 800445 . This is a "DEPT OF MENTAL HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 405495 . This is a "HEALTH CARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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