Healthcare Provider Details

I. General information

NPI: 1447531439
Provider Name (Legal Business Name): TODD ALAN WHITLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 JOHN ST
EVANSVILLE IN
47713-2746
US

IV. Provider business mailing address

815 JOHN ST
EVANSVILLE IN
47713-2746
US

V. Phone/Fax

Practice location:
  • Phone: 812-454-8829
  • Fax:
Mailing address:
  • Phone: 812-454-8829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3400627A
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number87000699A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: