Provider Demographics
NPI:1245406362
Name:WHITEHURST, JAYLENE MCCRARY (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JAYLENE
Middle Name:MCCRARY
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 COUNTY ROAD 151
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6825
Mailing Address - Country:US
Mailing Address - Phone:662-808-0902
Mailing Address - Fax:
Practice Address - Street 1:47 COUNTY ROAD 151
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6825
Practice Address - Country:US
Practice Address - Phone:662-808-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1204101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor