=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922960111
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WHITNEY CLARK RIGGS HAAKSMA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2025
-----------------------------------------------------
Last Update Date | 11/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12617 S MCLOUD RD
-----------------------------------------------------
City | MCLOUD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74851-8509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-481-4755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11300 SE 15TH ST APT 717
-----------------------------------------------------
City | MIDWEST CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73130-7819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------