Healthcare Provider Details

I. General information

NPI: 1568459741
Provider Name (Legal Business Name): JEAN P WHITINGER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SUNSET DR SUITE 410
JOHNSON CITY TN
37604-2517
US

IV. Provider business mailing address

208 SUNSET DR SUITE 410
JOHNSON CITY TN
37604-2517
US

V. Phone/Fax

Practice location:
  • Phone: 423-943-1139
  • Fax: 423-915-0862
Mailing address:
  • Phone: 423-943-1139
  • Fax: 423-915-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number198
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: