Provider Demographics
NPI:1093874711
Name:WHITEHEAD, DANIEL A SR (MHR, LPC, LMHP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:WHITEHEAD
Suffix:SR
Gender:M
Credentials:MHR, LPC, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 MAASS RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-6037
Mailing Address - Country:US
Mailing Address - Phone:402-968-5663
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST
Practice Address - Street 2:SUITE 536
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2939
Practice Address - Country:US
Practice Address - Phone:402-968-5663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2016-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health