MEDICARE: DALE MITCHELL WHITMAN LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH00005725	WA

General Provider Information

NPI Number	:	1245313048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE MITCHELL WHITMAN LMHC

Provider Business Mailing Address
First Line	:	4202 MERIDIAN ST
Second Line	:	SUITE 203
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8760
Country	:	US
Telephone Number	:	360-676-9535
Fax Number	:	360-733-4339

Provider Business Practice Location Address
First Line	:	4202 MERIDIAN ST
Second Line	:	SUITE 203
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8760
Country	:	US
Telephone Number	:	360-676-9535
Fax Number	:	360-733-4339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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