Provider Demographics
NPI:1073263075
Name:WHITMORE, BRIAN ASHLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ASHLEY
Last Name:WHITMORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1190
Mailing Address - Street 2:
Mailing Address - City:PALISADE
Mailing Address - State:CO
Mailing Address - Zip Code:81526-1190
Mailing Address - Country:US
Mailing Address - Phone:970-778-9260
Mailing Address - Fax:
Practice Address - Street 1:204 W 6TH ST
Practice Address - Street 2:
Practice Address - City:PALISADE
Practice Address - State:CO
Practice Address - Zip Code:81526-5019
Practice Address - Country:US
Practice Address - Phone:970-778-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099238811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical