Healthcare Provider Details

I. General information

NPI: 1821899253
Provider Name (Legal Business Name): COURTNEY WHITAKER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 S CHARLESTON AVE
SPRINGFIELD MO
65804-4370
US

IV. Provider business mailing address

1304 S 15TH ST
OZARK MO
65721-7480
US

V. Phone/Fax

Practice location:
  • Phone: 417-501-6678
  • Fax:
Mailing address:
  • Phone: 417-848-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025006028
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: