Provider Demographics
NPI:1184014946
Name:WHITWORTH, CHRISTINE RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENEE
Last Name:WHITWORTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:RENEE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-1727
Mailing Address - Country:US
Mailing Address - Phone:417-448-9949
Mailing Address - Fax:417-530-1438
Practice Address - Street 1:1601 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-1727
Practice Address - Country:US
Practice Address - Phone:174-489-9949
Practice Address - Fax:417-530-1438
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017009484101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health