Healthcare Provider Details

I. General information

NPI: 1598112179
Provider Name (Legal Business Name): LAWRENCE WHITAKER M.A.;LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 GLACIER HWY
JUNEAU AK
99801-9501
US

IV. Provider business mailing address

3406 GLACIER HWY
JUNEAU AK
99801-9501
US

V. Phone/Fax

Practice location:
  • Phone: 907-463-3303
  • Fax: 907-463-6858
Mailing address:
  • Phone: 907-463-3303
  • Fax: 907-463-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number106271
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: