Provider Demographics
NPI:1326683814
Name:WHARTON, JACOB LATON (LPC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:LATON
Last Name:WHARTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 N RIVERSIDE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2566
Mailing Address - Country:US
Mailing Address - Phone:816-271-1301
Mailing Address - Fax:816-271-1302
Practice Address - Street 1:902 N RIVERSIDE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2566
Practice Address - Country:US
Practice Address - Phone:816-271-1301
Practice Address - Fax:816-271-1302
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3412101YP2500X
MO2017002434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional