Provider Demographics
NPI:1225068869
Name:WHITNEY, STEPHEN JR (MPC, LCPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:WHITNEY
Suffix:JR
Gender:M
Credentials:MPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-9215
Mailing Address - Country:US
Mailing Address - Phone:406-723-0190
Mailing Address - Fax:406-563-5794
Practice Address - Street 1:125 W GRANITE ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9215
Practice Address - Country:US
Practice Address - Phone:406-723-0190
Practice Address - Fax:406-563-5794
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT391101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT256734Medicaid