=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124326632
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD LEWIS WHITTON LMHC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2011
-----------------------------------------------------
Last Update Date | 02/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5214 4TH AVENUE CIR E
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34208-5621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-782-4150
-----------------------------------------------------
Fax | 941-782-4642
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9478
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34206-9478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-782-4299
-----------------------------------------------------
Fax | 941-782-4301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH10658
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------