=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285706630
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOALENE WHITMER LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14045 N 7TH ST SUITE 4
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85022-4388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-993-4595
-----------------------------------------------------
Fax | 602-993-7440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 914 W SAINT JOHN RD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85023-2663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-993-5570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC11851
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------