Healthcare Provider Details

I. General information

NPI: 1912398322
Provider Name (Legal Business Name): WHALEN THERAPEUTIC CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2015
Last Update Date: 11/27/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HWY 66
CATOOSA OK
74015
US

IV. Provider business mailing address

9195 E 580 RD
CATOOSA OK
74015
US

V. Phone/Fax

Practice location:
  • Phone: 918-264-4365
  • Fax: 888-975-3464
Mailing address:
  • Phone: 918-739-0340
  • Fax: 888-975-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5538
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5538
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2394
License Number StateKS

VIII. Authorized Official

Name: MRS. JACKIE LEE SCOTT
Title or Position: OWNER/CLINICIAN/SCHOOL PSYCHOLOGIST
Credential: LPC05538
Phone: 918-264-4365