Healthcare Provider Details

I. General information

NPI: 1639224462
Provider Name (Legal Business Name): LLOYD WAYNE WHYTE MSW LCSW MO LICENSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 SAVANNAH CT STE 101
COLUMBIA MO
65202-4250
US

IV. Provider business mailing address

4304 SAVANNAH CT
COLUMBIA MO
65202-4250
US

V. Phone/Fax

Practice location:
  • Phone: 573-446-0849
  • Fax:
Mailing address:
  • Phone: 573-446-0849
  • Fax: 573-446-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMO001674
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: