Provider Demographics
NPI:1164522777
Name:WHITAKER, HALL BRITTON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:HALL
Middle Name:BRITTON
Last Name:WHITAKER
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 1:12001 COUNTY ROAD 3160
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-8158
Mailing Address - Country:US
Mailing Address - Phone:573-364-7022
Mailing Address - Fax:573-364-7022
Practice Address - Street 1:12001 COUNTY ROAD 3160
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-8158
Practice Address - Country:US
Practice Address - Phone:573-364-7022
Practice Address - Fax:573-364-7022
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0016751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical