1437602786 NPI number — NATHAN WHITING MA, LPC, CSAC

Table of content: NATHAN WHITING MA, LPC, CSAC (NPI 1437602786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437602786 NPI number — NATHAN WHITING MA, LPC, CSAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITING
Provider First Name:
NATHAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, CSAC
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:
1437602786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 142
Provider Second Line Business Mailing Address:
405 E. LASALLE AVE.
Provider Business Mailing Address City Name:
BARRON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54812-0142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-296-3840
Provider Business Mailing Address Fax Number:
715-637-5749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 E. LASALLE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARRON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-296-3840
Provider Business Practice Location Address Fax Number:
715-637-5749
Provider Enumeration Date:
08/03/2016

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: 101YA0400X , with the licence number:  15915-132 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 6013125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1437602786 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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