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General NPI Number Information
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NPI Number | 1912398322
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Entity Type | Organization
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Legal Business Name | WHALEN THERAPEUTIC CENTER PLLC
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Dates
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Enumeration Date | 02/07/2015
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 1801 HWY 66
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City | CATOOSA
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State | OK
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Zip | 74015
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Country | US
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Telephone | 918-264-4365
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Fax | 888-975-3464
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Provider Business Mailing Address
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Address Line | 9195 E 580 RD
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City | CATOOSA
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State | OK
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Zip | 74015
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Country | US
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Telephone | 918-739-0340
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Fax | 888-975-3464
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Authorized Official
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Title or Position | OWNER/CLINICIAN/SCHOOL PSYCHOLOGIST
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Name | MRS. JACKIE LEE SCOTT
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Credential | LPC05538
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Telephone | 918-264-4365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5538
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2394
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5538
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License Number State | OK
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